Improvement in Insulin Sensitivity and Β-Cell Function Following Ileal Interposition with Sleeve Gastrectomy in Type 2 Diabetic Patients: Potential Mechanisms

Paula, Aureo Ludovico de; Stival, Alessandro R.; Halpern, Alfredo; DePaula, Carolina C. L.; Mari, Andrea; Muscelli, Elza; Vencio, Sérgio; Ferrannini, Ele

doi:10.1007/s11605-011-1550-6

Cited by 51 publications

(26 citation statements)

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“…In rats, the operation significantly improves glucose metabolism without weight loss and increases the secretion of GLP-1 and PYY [85,86]. In humans, the procedure combined with sleeve gastrectomy induced improved insulin sensitivity and beta cell function [87] and consequently improved glycaemic control [88].…”

Section: Discussionmentioning

confidence: 99%

Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass

et al. 2012

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Roux-en-Y gastric bypass (RYGB) greatly improves glycaemic control in morbidly obese patients with type 2 diabetes, in many even before significant weight loss. Understanding the responsible mechanisms may contribute to our knowledge of the pathophysiology of type 2 diabetes and help identify new drug targets or improve surgical techniques. This review summarises the present knowledge based on pathophysiological studies published during the last decade. Taken together, two main mechanisms seem to be responsible for the early improvement in glycaemic control after RYGB: (1) an increase in hepatic insulin sensitivity induced, at least in part, by energy restriction and (2) improved beta cell function associated with an exaggerated postprandial glucagon-like peptide 1 secretion owing to the altered transit of nutrients. Later a weight loss induced improvement in peripheral insulin sensitivity follows.

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Section: Discussionmentioning

confidence: 99%

Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass

et al. 2012

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“…Although BPD and DS provide the highest rates of remission in terms of weight control and glycemic regulation, they are still being practiced by less than 3% of the bariatric community since these techniques require a life-long multi drug supplementation and may eventually necessitate a revisional surgery. Theoretical steps of success in the field of Bariatric & Metabolic Surgery are listed below: [7,8,18] 1. Caloric restriction and weight adjustments 2.…”

Section: Discussionmentioning

confidence: 99%

“…To this end, the only surgical method applied to overweight type 2 diabetic patients from the start has been ileal transposition (IT). [7,8] However, recent popular approach is to adapt obesity surgery procedures like gastric bypass to overweight patients and name them as "Metabolic Surgery". The purpose of this article was to discuss surgical procedures with specific emphasis on IT and review possible solutions against probable scenarios awaiting us in the future.…”

Section: Metabolic Surgerymentioning

confidence: 99%

“…IT maximizes distal gut activity interposing a segment of ileum right after the stomach and minimizes proximal activity excluding the duodenum. [7,8] TB enhances distal activity bringing the whole ileum to the antrum and diminishes proximal activity shifting food from the duodenal route, which is left intact, further minimizing malabsorption (and amplifying endoscopic access, instead of reducing it). Both procedures aim at functional (and not the mechanical) restriction, trying to avoid malabsorption, instead of having it as a beneficial goal.…”

Section: Which Operation?mentioning

confidence: 99%

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Ileal interposition with sleeve gastrectomy for the treatment of type 2 diabetes

Çelik¹

2017

Laparosc Endosc Surg Sci

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Metabolic syndrome and 2 of its most important components, obesity and type 2 diabetes, have reached pandemic proportions threatening the entire world. Initial treatment options directed at life style changes, including diet and exercise, have failed to achieve desired results for an important portion of patients and status of considerable number of patients has eventually become worse than pre-treatment due to reactive weight regain. Currently, the most effective treatment for obesity and type 2 diabetes is, without doubt, surgical procedure. There is no treatment option that can achieve remission for all of the components of metabolic syndrome with over 90% efficiency. However, it should be known that there are numerous methods used for surgical treatment of metabolic syndrome, and all have advantages, disadvantages, and restrictions of their own. Also, each has its own rate of efficiency. Aim of this article was to provide a brief understanding of mechanisms of action and to analyze outcomes of diverted sleeve gastrectomy with ileal transposition as functional restrictive therapeutic option for obese and non-obese patients with type 2 diabetes.

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“…Há evidências que os melhores resultados em termos de resolução da DM2 em pacientes obesos mórbidos são atingidos com as derivações biliopancreáticas, em especial o duodenal switch 1,5,6,7,8,10 . Essas operações caracterizam-se por redução do estômago através de gastrectomia e o rápido trânsito dos alimentos para o íleo distal, através de expressiva derivação de segmentos do intestino delgado.…”

Section: Introductionunclassified

Aspectos técnicos da interposição ileal com gastrectomia vertical como possível opção ao tratamento do diabetes mellitus tipo 2

Paula

Silva

Paula

et al. 2010

ABCD, arq. bras. cir. dig.

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DESCRITORES -Obesidade. Diabetes mellitus. Cirurgia Bariátrica.RESUMO -Introdução -Há evidências que os melhores resultados em termos de resolução do diabetes mellitus tipo 2 (DM2) em pacientes obesos mórbidos são atingidos com as derivações biliopancreáticas, em especial o duodenal switch. Essas operações caracterizamse por redução do estômago através de gastrectomia e o rápido trânsito dos alimentos para o íleo distal, através de expressiva derivação de segmentos do intestino delgado. A idéia da realização da técnica aqui apresentada baseou-se nestes princípios. Método -Os procedimentos são habitualmente realizados por via laparoscópica após pneumoperitônio com 12 a 15 mmHg e seis trocárteres. O paciente é inicialmente posicionado em proclive de 30º com o cirurgião à direita. Inicia-se a gastrectomia vertical tendo como referência anatômica a trifurcação distal do vago anterior. A desvascularização da grande curvatura é realizada e se estende até o ângulo esofagogástrico. Com um calibrador intra-gástrico de 20 mm posicionado ao longo da pequena curvatura gástrica inicia-se a ressecção gástrica no antro com grampeador linear e adicionalmente é feita uma sutura contínua. Para a realização da interposição ileal na altura do jejuno proximal o ângulo duodenojejunal é identificado e o jejuno seccionado 20 a 30 cm à jusante com grampeador linear. O ceco é identificado e o íleo distal seccionado a 30 cm no sentido proximal. Um segmento de 150 a 170 cm de íleo é medido em sentido proximal e seccionado com grampeador linear. O segmento de íleo é interposto de forma isoperistáltica no jejuno proximal previamente seccionado. Em seguida, são realizadas três enteroanastomoses: a primeira íleo-ileal próxima ao ceco; outra próxima ao ângulo duodenojejunal; a terceira íleo-jejunal. O procedimento pode também ser feito com interposição ileal na primeira porção do duodeno. Conclusão -Esta técnica demonstrou-se segura, com baixa morbidade e mortalidade, factível cirurgicamente pela via laparoscópica e passível de ser ofertada como opção operatória ao tratamento da diabetes mellitus tipo 2.ABSTRACT -Introduction -There is an evidence that the best results in terms of resolution of diabetes in morbidly obese patients are achieved with bilio-pancreatic bypass, especially the duodenal switch. These operations are characterized by partial gastrectomy and the rapid transit of food into the distal ileum through derivation of a significant segment of small intestine. The idea of performing the technique presented here was based on these principles. Method -The procedures are usually performed laparoscopically, after establishment of a pneumoperitoneum at 12-15 mmHg and introduction of six trocars. The patient is initially positioned in 30° reverse Trendelenburg with the surgeon on the right side of the patient. The sleeve gastrectomy is performed using the anatomical distal trifurcation of the anterior vagus nerve as a reference. The devascularization of the greater curvature is performed and extends to the oesophagogastric junction. Wit...

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Improvement in Insulin Sensitivity and Β-Cell Function Following Ileal Interposition with Sleeve Gastrectomy in Type 2 Diabetic Patients: Potential Mechanisms

Abstract: LII-SG induced changes on T2DM by mechanisms in part distinct from weight loss, principally involving restoration of insulin sensitivity and improvement of ß-cell function.

Cited by 51 publications

References 33 publications

Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass

Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass

Ileal interposition with sleeve gastrectomy for the treatment of type 2 diabetes

Aspectos técnicos da interposição ileal com gastrectomia vertical como possível opção ao tratamento do diabetes mellitus tipo 2

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