Narrative Review: Effect of Bariatric Surgery on Type 2 Diabetes Mellitus

Vetter, Marion L.; Cardillo, Serena; Rickels, Michael R.; Iqbal, Nayyar

doi:10.7326/0003-4819-150-2-200901200-00007

Cited by 165 publications

(142 citation statements)

References 84 publications

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“…56,58 Bariatric surgery is the most effective method of inducing and maintaining weight loses of 15% (gastric banding) to 25% (gastric bypass). 40,42 Surgery has been shown to ameliorate (or fully control) co-morbid conditions, particularly type 2 diabetes, 40,59 and in a matched cohort study, to reduce mortality. 60 Surgery also carries the highest risks of complications, including peri-operative mortality.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Obesity in Primary Care Practice in the United States: A Systematic Review

2009

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OBJECTIVES: This review examines the results of randomized controlled trials in which behavioral weight loss interventions, used alone or with pharmacotherapy, were provided in primary care settings.DATA SOURCES: Literature search of MEDLINE, PubMed, Cochrane Systematic Reviews, CINAHL, and EMBASE (1950-present). Inclusion criteria for studies were: (1) randomized trial, (2) obesity intervention in US adults, and (3) conducted in primary care or explicitly intended to model a primary care setting. REVIEW METHODS:Both authors reviewed each study to extract treatment modality, provider, setting, weight change, and attrition. The CONSORT criteria were used to assess study quality. Due to the small number and heterogeneity of studies, results were summarized but not pooled quantitatively.

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Section: Discussionmentioning

confidence: 99%

Treatment of Obesity in Primary Care Practice in the United States: A Systematic Review

2009

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“…Changes in the gastrointestinal hormones may be the key factors for improving T2DM. [23][24][25] In the current study, we found that the SG/MJIB and SG surgeries induced a decreased fasting ghrelin and increased GLP-1 levels at 2 and 16 weeks postoperatively. Ghrelin, which is mainly produced by the gastric fundus, can inhibit insulin sensitivity and secretion.…”

Section: 12mentioning

confidence: 64%

Sleeve Gastrectomy With Modified Jejunoileal Bypass Model in Goto-Kakizaki Rats

Zhu

Yang

Wang³

et al. 2016

International Surgery

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The objective of this study was to develop a nonobese diabetic rat model for sleeve gastrectomy with modified jejunoileal bypass (SG/MJIB) and to investigate its effectiveness and safety for inducing diabetic control. Thirty-five 13-week-old male Goto-Kakizaki rats were randomly assigned to the pair-fed to sham-operated SG/MJIB (PFSO-SG/MJIB), SG/MJIB, PFSO-SG, SG, and control groups. The experimental period was 16 weeks postoperatively. Body weight; food intake; glycemic control outcomes; and ghrelin, glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic peptide, and insulin levels were measured. The operated and PFSO groups showed significant weight loss 4 weeks postoperatively compared with the controls. The SG/MJIB and SG groups exhibited a significant improvement in oral glucose tolerance and insulin tolerance compared with the PFSO and control groups. The improved effects in the SG/MJIB group were better than those in the SG group. The SG/MJIB and SG groups showed decreased fasting ghrelin levels and increased levels of GLP-1 secretion 2 and 16 weeks postoperatively. Compared with the SG group, only the SG/MJIB group showed higher glucose-stimulated GLP-1 levels and significantly improved insulin secretion. SG/MJIB may be an effective, steady hypoglycemic surgical model, showing better diabetic control than SG. The hindgut may play a direct role in ameliorating glucose homeostasis. More than 90% of patients with diabetes have type 2 diabetes mellitus (T2DM). Even with strict hyperglycemia control, evidence for reducing complications related to T2DM has been reported 2 ; nevertheless, current therapies, such as diet, exercise, behavior modification, oral hypoglycemic agents, and insulin, can rarely help patients return 3 Recent data proved that the most reliable treatment for the long-term management of T2DM is surgical intervention.4-6 Surgical techniques for T2DM treatment are based on intake restriction, malabsorption, or both of these. However, none of the currently performed operations can provide unanimous treatment effects or a clear therapeutic mechanism. 7,8 Among the operations performed, adjustable gastric banding achieves hypoglycemia mainly through a limited food intake. Although this surgical method is relatively safe, the glycemic regulatory effect is far from satisfactory; complications, such as intragastric erosion or band slippage, may occur 9 ; and the reoperation rate may be .10%.10 Jejunoileal bypass (JIB) has been the most effective T2DM treatment 11 ; however, because of its severe complications, JIB has been abandoned by most surgeons. 12 Other procedures that combine gastritis and malabsorption, such as Roux-en-Y bypass, exclude most parts of the stomach, making this organ and the biliary ducts inaccessible to the usual endoscopic examinations, 13,14 which is not very suitable in high-risk patients. 15Recently, sleeve gastrectomy (SG) was reported with a hypoglycemic effect similar to that of Rouxen-Y bypass. 4 However, the use of SG cannot explain the mechanism of T2DM...

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“…2,6,7,17,18 Bariatric surgery is only part of the management of severe obesity. Careful patient selection and preparation are extremely important, as are long-term compliance with diet, nutritional supplementation and follow up.…”

Section: Types Of Surgerymentioning

confidence: 99%

Overview of bariatric surgery for the physician

Hng

Ang

2012

Clinical Medicine

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-The worldwide pandemic of obesity carries alarming health and socioeconomic implications. Bariatric surgery is currently the only effective treatment for severe obesity. It is safe, with mortality comparable to that of cholecystectomy, and effective in producing substantial and sustainable weight loss, along with high rates of resolution of associated comorbidities, including type 2 diabetes. For this reason, indications for bariatric surgery are being widened. In addition to volume restriction and malabsorption, bariatric surgery brings about neurohormonal changes that affect satiety and glucose homeostasis. Increased understanding of these mechanisms will help realise therapeutic benefits by pharmacological means. Bariatric surgery improves long-term mortality but can cause long-term nutritional deficiencies. The safety of pregnancy after bariatric surgery is still being elucidated.

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Narrative Review: Effect of Bariatric Surgery on Type 2 Diabetes Mellitus

Cited by 165 publications

References 84 publications

Treatment of Obesity in Primary Care Practice in the United States: A Systematic Review

Treatment of Obesity in Primary Care Practice in the United States: A Systematic Review

Sleeve Gastrectomy With Modified Jejunoileal Bypass Model in Goto-Kakizaki Rats

Overview of bariatric surgery for the physician

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