Metabolic Surgery for Non-Obese Type 2 Diabetes

Geloneze, Bruno; Geloneze, Sylka Rodovalho; Chaim, Élinton Adami; Hirsch, Fernanda Filgueira; Felici, Ana Claudia; Lambert, Giselle; Tambascia, Marcos Antônio; Pareja, José Carlos

doi:10.1097/sla.0b013e3182592c62

Cited by 55 publications

(11 citation statements)

References 34 publications

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“…Moreover, no study showed an increase in adiponectin due to a given procedure not also possibly explained by weight loss. The only studies which did not show a change in adiponectin were one showing a decrease in adiponectin after medical weight loss (85) and a study of duodenal-jejunal bypass in which the surgical group did not show a significant change in fat mass or BMI (86). It thus seems most likely that adiponectin production is increased secondary to weight loss in all procedures, since it is increased by weight loss of any kind, including medical weight loss.…”

Section: Resultsmentioning

confidence: 99%

Metabolic surgery: Action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature

Sweeney

Morton

2014

Best Practice & Research Clinical Gastroenterology

108

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Obesity and type 2 diabetes remain epidemic problems. Different bariatric surgical techniques causes weight loss and diabetes remission to varying degrees. The underlying mechanisms of the beneficial effects of bariatric surgery are complex, and include changes in diet and behavior, as well as changes in hormones, bile acid flow, and gut bacteria. We summarized the effects of multiple different bariatric procedures, and their resulting effects on several hormones (leptin, ghrelin, adiponectin, glucagon-like peptide 1 (GLP-1), peptide YY, and glucagon), bile acid changes in the gut and the serum, and resulting changes to the gut microbiome. As much as possible, we have tried to incorporate multiple studies to try to explain underlying mechanistic changes. What emerges from the data is a picture of clear differences between restrictive and metabolic procedures. The latter, in particular the roux-en-Y gastric bypass, induces large and distinctive changes in most measured fat and gut hormones, including early and sustained increase in GLP-1, possible through intestinal bile acid signaling. The changes in bile flow and the gut microbiome are causally inseparable so far, but new studies show that each contributes to the effects of weight loss and diabetes resolution.

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Section: Resultsmentioning

confidence: 99%

Metabolic surgery: Action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature

Sweeney

Morton

2014

Best Practice & Research Clinical Gastroenterology

108

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“…The exception was an investigation of an experimental operation that replicates the proximal intestinal bypass of RYGB without affecting the stomach, i.e., duodenal-jejunal bypass surgery. It caused substantially greater glycemic control than did nonsurgical care, despite equal weight change in both groups, further demonstrating weight-independent antidiabetes effects of proximal intestinal bypass (33). As is commonly observed, the effects of surgery on blood pressure and plasma lipids were less impressive than those on glycemia.…”

Section: Evidence Regarding the Use Of Bariatric/metabolic Surgery Tomentioning

confidence: 96%

Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2

2016

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OBJECTIVEGlobal usage of bariatric surgery has been dictated for the past quarter century by National Institutes of Health recommendations restricting these operations to individuals with a BMI ≥35 kg/m2. Strong evidence now demonstrates that bariatric procedures markedly improve or cause remission of type 2 diabetes mellitus (T2DM), in part through weight-independent mechanisms, and that baseline BMI does not predict surgical benefits on glycemic or cardiovascular outcomes. This impels consideration of such operations as “metabolic surgery,” which is used expressly to treat T2DM, including among patients with a BMI <35 kg/m2 who constitute the majority of people with diabetes worldwide. Here, we review available evidence to inform that consideration.RESULTSA meta-analysis of the 11 published randomized clinical trials (RCTs) directly comparing bariatric/metabolic surgery versus a variety of medical/lifestyle interventions for T2DM provides level 1A evidence that surgery is superior for T2DM remission, glycemic control, and HbA1c lowering. Importantly, this is equally true for patients whose baseline BMI is below or above 35 kg/m2. Similar conclusions derive from meta-analyses of high-quality nonrandomized prospective comparisons. Meta-analysis of all pertinent published studies indicates that T2DM remission rates following bariatric/metabolic surgery are comparable above and below the 35 kg/m2 BMI threshold. The safety, antidiabetes durability, and benefits on other cardiovascular risk factors from bariatric/metabolic surgery appear roughly comparable among patients with a BMI below or above 35 kg/m2. Further studies are needed to extend long-term findings and measure “hard” macrovascular/microvascular outcomes and mortality in RCTs.CONCLUSIONSExtant data, including level 1A evidence from numerous RCTs, support new guidelines from the 2nd Diabetes Surgery Summit that advocate for the consideration of bariatric/metabolic surgery as one option, along with lifestyle and medical therapy, to treat T2DM among patients with a BMI <35 kg/m2.

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“…This procedure involves repositioning the intestinal tract without restriction or exclusion of the stomach. Although DJB does not elicit the same weight loss effects as RYGB or BPD, this procedure has been shown to produce glucoselowering effects in nonobese rodents (Rubino et al 2004), and in a small subset of nonobese or mild-obese humans with type 2 diabetes, independent of weight loss (Cohen et al 2007, Lee et al 2010, Geloneze et al 2012. Moreover, in Asia, a novel surgery similar to a BPD-DS has been developed that involves a DJB with VSG, and has demonstrated initial success in the treatment of diabetes (Kasama et al 2009.…”

Section: Bariatric Surgerymentioning

confidence: 99%

Targeting the gastrointestinal tract to treat type 2 diabetes

Bauer

Duca

2016

Journal of Endocrinology

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The rising global rates of type 2 diabetes and obesity present a significant economic and social burden, underscoring the importance for effective and safe therapeutic options. The success of glucagon-like-peptide-1 receptor agonists in the treatment of type 2 diabetes, along with the potent glucose-lowering effects of bariatric surgery, highlight the gastrointestinal tract as a potential target for diabetes treatment. Furthermore, recent evidence suggests that the gut plays a prominent role in the ability of metformin to lower glucose levels. As such, the current review highlights some of the current and potential pathways in the gut that could be targeted to improve glucose homeostasis, such as changes in nutrient sensing, gut peptides, gut microbiota and bile acids. A better understanding of these pathways will lay the groundwork for novel gut-targeted antidiabetic therapies, some of which have already shown initial promise.

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Metabolic Surgery for Non-Obese Type 2 Diabetes

Abstract: Duodenal-jejunal bypass improved insulin sensitivity and β-cell function and reduced glucose-insulinotropic polypeptide, leptin, and glucagon production. Hence, DJB resulted in better glycemic control and reduction in insulin requirement but DJB did not result in remission of diabetes.

Cited by 55 publications

References 34 publications

Metabolic surgery: Action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature

Metabolic surgery: Action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature

Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2

Targeting the gastrointestinal tract to treat type 2 diabetes

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Metabolic Surgery for Non-Obese Type 2 Diabetes

Abstract: Duodenal-jejunal bypass improved insulin sensitivity and β-cell function and reduced glucose-insulinotropic polypeptide, leptin, and glucagon production. Hence, DJB resulted in better glycemic control and reduction in insulin requirement but DJB did not result in remission of diabetes.

Cited by 55 publications

References 34 publications

Metabolic surgery: Action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature

Metabolic surgery: Action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature

Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI &lt;35 kg/m2

Targeting the gastrointestinal tract to treat type 2 diabetes

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Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2