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Insulin sensitivity and secretion modifications after bariatric surgery
No full textType 2 diabetes mellitus is increasing over time as result of the obesity epidemics. In fact, the prevalence of Type 2 diabetes across Europe in 2010 was estimated to be 8.2% of the population and its projection for 2030 sees figures of 10.1%. This increase in the number of diabetic individuals has also dramatically raised the health expense, with spending on diabetes in Europe in 2010 accounting for 10% of the total healthcare cost. A meta-analysis of the literature evidenced that the clinical and laboratory manifestations of Type 2 diabetes are resolved in 78.1%, and are improved in 86.6% of obese patients (body mass index >35 kg/m2) after bariatric surgery. However, a gradation of effects of different surgical techniques in improving glucose control does exist, with the largest and durable effects observed in prevalently malabsorptive procedures. The outcome of bariatric surgery on insulin sensitivity and secretion is different in relation to the type of operation performed. In fact, while Roux-en-Y Gastric Bypass enhances insulin secretion after a meal thus improving glucose metabolism, Bilio-Pancreatic Diversion acts through the amelioration of insulin sensitivity allowing a subsequent reduction of insulin hypersecretion, which is a typical feature of the insulin resistance state. Gastric banding action is mediated uniquely through the weight loss, and the effect of sleeve gastrectomy is still to be elucidated. Incretin secretion is dramatically increased under nutrient stimulation after gastric bypass leading, probably, to an overstimulation of pancreatic β-cells resulting in the increase of insulin secretio
Short‐term weight‐mediated effects of sleeve gastrectomy on echocardiographic surrogate markers of atherosclerotic vascular disease
Full text linkType 2 diabetes mellitus in 2013: A central role of the gut in glucose homeostasis
No full textMetabolic surgery has been proven to be effective in inducing remission of type 2 diabetes mellitus prior to any significant weight reduction. Studies in 2013 have investigated the mechanisms of action of these procedures and have highlighted a central role of the small intestine in the effects on glucose homeostasis
Effect of Diet versus Gastric Bypass on Metabolic Function in Diabetes
Full text linkoshino et al. found that an 18% reduction in body weight improves insulin sensitivity similarly after gastric bypass or dieting in participants with obesity and type 2 diabetes. They conclude that their study results “challenge the current belief that upper gastrointestinal bypass has clinically meaningful effects on key metabolic factors involved in glucose homeostasis and the pathogenesis of diabetes that are independent of weight loss.”
Nevertheless, in a recent article,1 the same research group reported that, after a 20% reduction in body weight, biliopancreatic diversion improved insulin sensitivity significantly more than gastric bypass. How do the authors reconcile these differing results? Furthermore, we note that the participants in the diet group in the study conducted by Yoshino et al. had less severe diabetes than those in the surgery group and appeared to use fewer medications, or no medications (mean [±SD] diabetes medication score [on a scale from 0 to 3.57, with a higher score indicating a greater number of medications, a higher dosage of medications, or both], 0.93±0.55 vs. 1.64±1.15)
Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery
No full textBariatric surgery represents the main option for obtaining substantial and long-term weight loss in morbidly obese subjects. In addition, malabsorptive (biliopancreatic diversion, BPD) and restrictive (roux-en-Y gastric bypass, RYGB) surgery, originally devised to treat obesity, has also been shown to help diabetes. Indeed, type 2 diabetes is improved or even reversed soon after these operations and well before significant weight loss occurs. Two hypotheses have been proposed to explain the early effects of bariatric surgery on diabetes--namely, the hindgut hypothesis and the foregut hypothesis. The former states that diabetes control results from the more rapid delivery of nutrients to the distal small intestine, thereby enhancing the release of hormones such as glucagon-like peptide-1 (GLP-1). The latter theory contends that exclusion of the proximal small intestine reduces or suppresses the secretion of anti-incretin hormones, leading to improvement of blood glucose control as a consequence. In fact, increased GLP-1 plasma levels stimulate insulin secretion and suppress glucagon secretion, thereby improving glucose metabolism. Recent studies have shown that improved intestinal gluconeogenesis may also be involved in the amelioration of glucose homoeostasis following RYGB. Although no large trials have specifically addressed the effects of bariatric surgery on the remission or reversal of type 2 diabetes independent of weight loss and/or caloric restriction, there are sufficient data in the literature to support the idea that this type of surgery--specifically, RYGB and BPD--can lead to early improvement of glucose control independent of weight loss
Editorial: Women in surgical oncology: 2021
Full text linkCurrently, female researchers represent merely a minority, accounting for an
estimated 29.3% who end up covering this position worldwide, with a great variability
according to each country (1). Specifically, Central Asia exhibits the greatest proportion
of female researchers with an estimated 48.2% as opposed to South and West Asia with
the lowest count globally (i.e. 18.5%) (1).
In response to such a large gender gap in the scientific research community, the
UNESCO Institute for Statistics (UIS) is in the midst of developing new indicators in
order to better comprehend the reasons behind women’s decisions to pursue one career
over another. Several could be the reasons implicated in limiting and discouraging
women’s access to the scientific community, including ancient biases and gender
stereotypes. By further understanding such issues, the UIS project concurrently aims
at reducing the gender inequality in science, technology, engineering and mathematics
(STEM) fields, by possibly promoting reforms in policies and implementing changes in
favor of gender equality in all countries with the ultimate goal of empowering women (2
Metabolic surgery; indications and outcomes
No full textBariatric surgery has a large number of benefits other than weight loss, including improved control of glycemia-up to diabetes remission-, blood pressure, and dyslipidaemia, while mortality due to cardiovascular disease and female cancers are also reduced, often independent of body weight reduction. For these reason bariatric surgery was renamed as metabolic surgery. In this review of the literature we report the effects of metabolic surgery on mortality reduction, type 2 diabetes and its vascular complications, hypertension, hyperlipidemia, obstructive sleep apnea, sexual dysfunction and appetite reduction and food preferences in the short and long term
Intestinal peptide changes after bariatric and minimally invasive surgery: Relation to diabetes remission
No full textBariatric surgery is very effective in achieving and maintaining weight loss but it is also associated with improvement of obesity metabolic complications, primarily type 2 diabetes (T2D). Remission of T2D or at least a net improvement of glycemic control persists for at least 5 years. The bypass of duodenum and of the first portion of the jejunum up to the Treitz ligament as in Roux-en-Y Gastric Bypass (RYGB), or the bypass of the duodenum, the entire jejunum and the first tract of the ileum, such as in Bilio-Pancreatic Diversion (BPD), achieve different results on insulin sensitivity. Insulin resistance is the major driver of T2D manifesting long before insulin secretion failure. In fact, T2D development can be prevented by treatment with insulin sensitizing agents. Interestingly, RYGB improves hepatic insulin sensitivity while BPD ameliorates whole-body insulin sensitivity. Two major theories have been advocated to explain the early remission of T2D following RYGB or BPD before a meaningful weight loss takes place, the foregut and the hindgut hypotheses. The former holds that the bypass of the proximal intestine, i.e. duodenum and jejunum, prevents the secretion of signals − including nervous transmitters and hormones − promoting insulin resistance, the latter instead states that the delivery of nutrients directly into the ileum stimulates the secretion of hormones improving glucose disposal. The most studied candidate is Glucagon Like Peptide 1 (GLP1). However, while there is unambiguous evidence that GLP-1 stimulates insulin secretion, its direct action in lowering insulin resistance, independently of the effect on weight loss secondary to its satiety action, is utterly controversial. In this review we examine the effects on T2D and gastrointestinal peptide secretion produced by different types of metabolic surgery and by minimally invasive endoscopic surgery, whose utilization for the treatment of obesity and T2D is gaining wider interest and acceptance
Obesity surgery and cancer. What are the unanswered questions?
Full text linkObesity has become a global epidemic with a soaring economic encumbrance due
to its related morbidity and mortality. Amongst obesity-related conditions, cancer is
indeed the most redoubtable. Bariatric surgery has been proven to be the most
effective treatment for obesity and its associatedmetabolic and cardiovascular disorders.
However, the understanding of whether and how bariatric surgery determines a
reduction in cancer risk is limited. Obesity-related malignancies primarily include
colorectal and hormone-sensitive (endometrium, breast, prostate) cancers. Additionally,
esophago-gastric tumors are growing to be recognized as a new category mainly
associated with post-bariatric surgery outcomes. In fact, certain types of surgical
procedures have been described to induce the development and subsequent
progression of pre-cancerous esophageal and gastric lesions. This emerging category is
of great concern and further research is required to possibly prevent such risks. Published
data has generated conflicting results. In fact, while overall cancer risk reduction was
reported particularly in women, some authors showed no improvement or even increased
cancer incidence. Although various studies have reported beneficial effects of surgery
on risk of specific cancer development, fundamental insights into the pathogenesis of
obesity-related cancer are indispensable to fully elucidate its mechanisms
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