Early Glycaemic Control in Type 2 Diabetes Patients After Bariatric Surgery; ECODABS
Condition: Diabetes Mellitus Type 2 in Obese
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Observational

Summary: 
      Describe and characterize the time-course for improvement in glucose control after bariatric
      surgery in obese patients with type 2 diabetes

      Compare these changes in glycemic control after different techniques for bariatric surgery
    

Detailed description: 
      Obesity and its ensuing metabolic complications such as type 2 diabetes mellitus, are
      exponentially increasing worldwide. * * The most effective treatment for obesity is bariatric
      surgery. * Different bariatric procedures are available. In the 1960's, the Roux-en-Y gastric
      bypass (RYGB) was developed, in which the stomach is divided with staplers to create a small
      gastric pouch, while the jejunum is divided 30 to 50 cm distal to the ligament of Treitz. The
      distal limb is then anastomosed to the small gastric pouch and a jejunojejunostomy is
      performed 50 to 150 cm distal from the gastrojejunostomy. Sleeve gastrectomy on the other
      hand, reduces the stomach size by vertical stapling. In the 1990's, gastric banding was
      developed, reducing the volume of the stomach by annular banding. The amount of excess body
      weight reduction varies among the different techniques, with 60% to 70% reported for RYGB*,
      55% for sleeve gastrectomy* and up to 65% for gastric banding*. Worldwide, it is estimated
      that a total of 344000 procedures were performed in 2008. Roux-en-Y gastric bypass was the
      most common (47%) followed by gastric banding (42%) and sleeve gastrectomy (5%).*

      In 1987, Pories et al. published data on the stunning observation that 99% of obese patients
      with type 2 diabetes or impaired glucose tolerance that had undergone Roux-en-Y gastric
      bypass became and remained euglycemic after surgery.* Since then, all commonly used bariatric
      procedures have been shown to restore a normal glucose profile in many diabetes patients.
      Current data suggest that the bypass procedures are more effective in doing so, with success
      rates up to 80%,* than the purely restrictive procedures such as sleeve gastrectomy and
      gastric banding, with success rates varying between 30% and 70%.* The improvement in
      glycaemic control is already seen a few days after surgery, long before any substantial
      weight loss occurs.

      Although different reasons for the rapid amelioration in glycaemic control are discussed in
      literature, the exact underlying mechanisms are still not understood. In the restrictive
      procedures, the effect is thought to be mainly mediated by caloric restriction and the
      ensuing reduction in body weight and improvement in insulin resistance.* The malabsorptive
      procedures, such as RYGB, offer different explanatory possibilities. In the so-called
      'fore-gut hypothesis', it is suggested that the exclusion of the duodenum and proximal
      jejunum may reduce insulin resistance. * The 'hind-gut hypothesis' on the other hand,
      suggests that it is the altered delivery of nutrients to the distal small bowel that causes
      exaggerated responses of the gut hormones. These gut hormones act as anorectic agents and as
      incretins that stimulate the beta cells in the pancreas to restore normal first phase insulin
      response. *

      Most studies to investigate the alterations in glucose metabolism are performed weeks to
      months after surgery. There are limited data on the evolution of blood glucose in the first
      days and weeks after RYGB.* However, to our knowledge, no such data exist on the glycaemic
      control immediately after sleeve gastrectomy and gastric banding. With the present study we
      document the evolution in glycaemic control immediately after RYGB, sleeve gastrectomy and
      gastric banding in type 2 diabetic subjects.
    

Intervention name(s): Roux-en-Y gastric bypass; Sleeve gastrectomy
Intervention type(s): Procedure; Procedure
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        diabetes mellitus typ 2 and obesity
      
Biospecimen description: 
      Plasma Serum
    
Keywords: Glycemic control