Role of Gastrointestinal Hormones as a Predictive Factor for Long-Term Diabetes Remission: Randomized Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy, and Greater Curvature Plication.

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Tytuł:: Role of Gastrointestinal Hormones as a Predictive Factor for Long-Term Diabetes Remission: Randomized Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy, and Greater Curvature Plication.
Autorzy:: Casajoana A; Department of General and Gastrointestinal Surgery, Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Guerrero-Pérez F; Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
García Ruiz de Gordejuela A; Department of General Surgery, Endocrine, Bariatric and Metabolic Surgery Unit, Vall d'Hebron University Hospital, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
Admella V; Department of General and Gastrointestinal Surgery, Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Sorribas M; Department of General and Gastrointestinal Surgery, Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Vidal-Alabró A; Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Virgili N; Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Urdiales RL; Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Montserrat M; Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Pérez-Maraver M; Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Monasterio C; Department of Pneumology, Sleep Unit, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Salord N; Department of Pneumology, Sleep Unit, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Pellitero S; Department of Endocrinology and Nutrition and Health Sciences Research Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.
Fernández-Veledo S; Diabetes and Metabolic Associated Diseases Research Group, Hospital Universitari Joan XXIII-Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain.; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
Vendrell J; Diabetes and Metabolic Associated Diseases Research Group, Hospital Universitari Joan XXIII-Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain.; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.; School of Medicine, Universitat Rovira i Virgili, Tarragona, Spain.
Gebelli JP; Department of General and Gastrointestinal Surgery, Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Vilarrasa N; Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain. .; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain. .
Źródło:: Obesity surgery [Obes Surg] 2021 Apr; Vol. 31 (4), pp. 1733-1744. Date of Electronic Publication: 2021 Jan 05.
Typ publikacji:: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: 2006- : New York : Springer Science + Business Media
Original Publication: Oxford, OX, UK : Rapid Communications of Oxford, [1991-
MeSH Terms:: Diabetes Mellitus, Type 2*/surgery
Gastric Bypass*
Gastrointestinal Hormones*
Obesity, Morbid*/surgery
Gastrectomy ; Humans ; Treatment Outcome
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Contributed Indexing:: Keywords: Bariatric surgery; Diabetes remission; Greater curvature plication; Metabolic gastric bypass; Obesity; Sleeve; Type 2 diabetes mellitus
Substance Nomenclature:: 0 (Gastrointestinal Hormones)
Entry Date(s):: Date Created: 20210105 Date Completed: 20210419 Latest Revision: 20210419
Update Code:: 20240105
DOI:: 10.1007/s11695-020-05192-x
PMID:: 33398627
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Purpose: Long-term studies comparing the mechanisms of different bariatric techniques for T2DM remission are scarce. We aimed to compare type 2 diabetes (T2DM) remission after a gastric bypass with a 200-cm biliopancreatic limb (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP), and to assess if the initial secretion of gastrointestinal hormones may predict metabolic outcomes at 5 years.
Material and Methods: Forty-five patients with mean BMI of 39.4(1.9)kg/m 2 and T2DM with HbA 1c of 7.7(1.9)% were randomized to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and AUC of GLP-1 after SMT were determined prior to and at months 1 and 12 after surgery. At 5-year follow-up, anthropometrical and biochemical parameters were determined.
Results: Total weight loss percentage (TWL%) at year 1 and GLP-1 AUC at months 1 and 12 were higher in the mRYGB than in the SG and GCP. TWL% remained greater at 5 years in mRYGB group - 27.32 (7.8) vs. SG - 18.00 (10.6) and GCP - 14.83 (7.8), p = 0.001. At 5 years, complete T2DM remission was observed in 46.7% after mRYGB vs. 20.0% after SG and 6.6% after GCP, p < 0.001. In the multivariate analysis, shorter T2DM duration (OR 0.186), p = 0.008, and the GLP-1 AUC at 1 month (OR 7.229), p = 0.023, were prognostic factors for complete T2DM remission at 5-year follow-up.
Conclusions: Long-term T2DM remission is mostly achieved with hypoabsortive techniques such as mRYGB. Increased secretion of GLP-1 after surgery and shorter disease duration were the main predictors of T2DM remission at 5 years.

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