Bariatric/metabolic surgery and its role in the treatment of type 2 diabetes mellitus
Authors:
E. Konečná; E. Šimůnková; K. Šuta-Kimle; D. Michalský
Authors‘ workplace:
Přednosta: prof. MUDr. Zdeněk Krška, DrSc.
; I. chirurgická klinika 1. LF UK a VFN, Praha
Published in:
Prakt. Lék. 2019; 99(6): 245-252
Category:
Reviews
Overview
Bariatric surgeries, originally designed exclusively to achieve weight loss in morbidly obese patients, have also been unequivocally proven as having additional positive impacts on patients’ glycaemic profiles and limiting metabolic comorbidities. Based on these findings, metabolic surgery became a term for procedures not aimed to achieve weight loss as a primary outcome, but rather to help treat type 2 diabetes mellitus and other metabolic diseases tied to obesity. In light of the fact that both bariatric and metabolic effects are observed after a procedure, we prefer to call these procedures more aptly bariatric/metabolic surgery. Based on randomized studies, we confirmed higher efficacy of metabolic surgery for improving glycaemic profiles for patients in comparison to conservative approaches (i.e., lifestyle changes, diet regimes, or taking medicaments). These novel results place bariatric/metabolic surgery among standard procedures to treat type 2 diabetes mellitus. Additionally, our findings suggest lowering a current BMI recommendation threshold for a procedure for individuals with 35 BMI (kg/m2) down to 30 BMI (kg/m2).
Keywords:
metabolic surgery – obesity – bariatric surgery – type 2 diabetes mellitus
Sources
1. Buchwald H, Varco RL. (eds.) Metabolic surgery. New York: Grune and Stratton 1978.
2. Buchwald H. Lowering of cholesterol absorption and blood levels by ileal exclusion: experimental basis and preliminary clinical report. Circulation 1964; 29: 713–720.
3. Buchwald H, Campos CT, Varco RL, et al. Effective lipid modification by partial ileal bypass reduced long-term coronary heart disease mortality and morbidity: five-year posttrial follow-up report from the POSCH. Arch Intern Med 1998; 158: 1253–1261.
4. Buchwald H, Rucker RD. The history of metabolic surgery for morbid obesity and a commentary. World J Surg 1981; 5(6): 781–787.
5. Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery Worldwide 2013. Obes Surg 2015; 25(10): 1822–1832.
6. Leyton O. Diabetes and operation. Lancet 1925; 206(5336): 1162–1163.
7. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995; 222: 339–352.
8. Scopinaro N, Adami GF, Marinari G, et al. The effect of biliopancreatic diversion on glucose metabolism. Obes Surg 1997; 7(4): 297.
9. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg 2002; 236: 554–559.
10. Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg 2004; 240(2): 236–242.
11. Rubino F, Marescaux J. Effect of duodenal–jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg 2004; 239(1): 1–11.
12. Cohen RV, Schiavon CA, Pinheiro JS, et al. Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22–34 kg/m2: a report of 2 cases. Surg Obes Relat Dis 2007; 3(2): 195–197.
13. Ramos AC, Galvão Neto MP, de Souza YM, et al. Laparoscopic duodenal-jejunal exclusion in the treatment of type 2 diabetes mellitus in patients with BMI < 30 kg/m2 (LBMI). Obes Surg 2009; 19(3): 307–312.
14. Dixon JB, O‘Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 2008; 299(3): 316–323.
15. Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA 2012; 307(1): 56–65.
16. Rubino F, Kaplan LM, Schauer PR, et al. Diabetes Surgery Summit Delegates The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg 2010; 251(3): 399–405.
17. Rubino F, Nathan DM, Eckel RH, et al. Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care 2016; 39(6): 861–877.
18. Korner J, Leibel RL. To eat or not to eat-how the gut talks to the brain. N Engl J Med 2003; 349(10): 926–928.
19. Mingrone G, Castagneto-Gissey L. Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery. Diabetes Metab 2009; 35(6): 518–523.
20. Vrbíková J, Vondra K. Incretins. Vnitř. Lek. 2006; 52(10): 919–925.
21. Abraham EJ, Leech CA, Lin JC, et al. Insulinotropic hormone glucagon-like peptide-1 differentiation of human pancreatic islet-derived progenitor cells into insulin-producing cells. Endocrinology 2002; 143(8): 3152–3161.
22. Holst JJ. The physiology of glucagon-like peptide 1. Physiol Rev 2007; 87(4): 1409–1439.
23. Iltz JL, Baker DE, Setter SM, et al. Exenatide: an incretin mimetic for the treatment of type 2 diabetes mellitus. Clin Ther 2006; 28(5): 652–665.
24. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 2008 23; 299(3): 316–323.
25. Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2 years results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes and Endocrinol 2019; 7(5): 344–355.
26. Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 2011; 54(10): 2506–2514.
27. Isbell JM, Tamboli RA, Hansen EN, et al. The importance of caloric restriction in the early improvements in insulin sensitivity after Roux-en-Y gastric bypass surgery. Diabetes Care 2010; 33(7): 1438–1442.
28. Kirk E, Reeds DN, Finck BN, et al. Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction. Gastroenterology 2009; 136(5): 1552–1560.
29. Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 2006; 244(5): 741–749.
30. Scopinaro N, Marinari GM, Camerini GB, et al. Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: a long-term follow-up study. Diabetes Care 2005; 28(10): 2406–2411.
31. Pok EH, Lee WJ. Gastrointestinal metabolic surgery for the treatment of type 2 diabetes mellitus. World J Gastroenterol 2014; 21;20(39): 14315–14328.
32. Manning S, Pucci A, Batterham RL. GLP-1: a mediator of the beneficial metabolic effects of bariatric surgery? Physiology (Bethesda) 2015; 30(1): 50–62.
33. Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg 2008; 247(3): 401–407.
34. Cavin JB, Couvelard A, Lebtahi R, et al. Differences in alimentary glucose absorption and intestinal disposal of blood glucose after Roux-en-Y gastric bypass vs sleeve gastrectomy. Gastroenterology 2016; 150(2): 454–464.
35. Fang S, Suh JM, Reilly SM, et al. Intestinal FXR agonism promotes adipose tissue browning and reduces obesity and insulin resistance. Nat Med 2015; 21(2): 159–165.
36. Penney NC, Kinross J, Newton RC, et al. The role of bile acids in reducing the metabolic complications of obesity after bariatric surgery: a systematic review. Int J Obes 2015; 39(11): 1565–1574.
37. Ley RE, Turnbaugh PJ, Klein S, et al. Microbial ecology: human gut microbes associated with obesity. Nature 2006; 444(7122): 1022–1023.
38. Zhang H, DiBaise JK, Zuccolo A, et al. Human gut microbiota in obesity and after gastric bypass. Proc Natl Acad Sci USA 2009; 106(7): 2365–2370.
39. Vrieze A, Van Nood E, Holleman F, et al. Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome. Gastroenterology 2012; 143(4): 913–916.
40. Baothman OA, Zamzami MA, Taher I, et al. The role of gut microbiota in the development of obesity and diabetes. Lipids Health Dis 2016; 15: 108.
41. Aminian A, Brethauer SA, Kirwan JP, et al. How safe is metabolic/diabetes surgery? Diabetes Obes Metab 2015; 17(2): 198–201.
42. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg 2017; 27(9): 2279–2289.
43. Batterham RL, Cummings DE. Mechanisms of diabetes improvement following bariatric/metabolic surgery. Diabetes Care 2016; 39(6): 893–901.
44. Panunzi S, De Gaetano A, Carnicelli A, et al. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: do BMI or procedure choice matter? A meta-analysis. Ann Surg 2015; 261(3): 459–467.
45. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009; 122(3): 248–256.
46. Gill RS, Birch DW, Shi X, et al. Sleeve gastrectomy and type 2 diabetes mellitus: systematic review. Surg Obes Relat Dis 2010; 6(6): 707–713.
47. Vest AR, Heneghan HM, Agarwal S, et al. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart 2012; 98(24): 1763–1777.
48. Vest AR, Heneghan HM, Schauer PR, et al. Surgical management of obesity and the relationship to cardiovascular disease. Circulation 2013; 127(8): 945–959.
49. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes – 5year outcomes. N Engl J Med 2017; 376(7): 641–651.
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