| It is generally accepted that obese patients with T2 DM achieve significant and lasting weight loss and T2 DM remission after metabolic surgery.This remarkable effect can minimize the possibility of future complications,particularly the risk of cardiovascular disease.Although metabolic surgery has been shown in multiple studies to produce substantial durable weight loss and improve or cure T2 DM and metabolic syndrome,the effects of metabolic surgery on T2 DM and metabolic syndrome components in C hinese obese patients with T2 DM remain unk nown.This serial study has four sections to investigate the clinical utility of metabolic surgery,including the effectiveness of metabolic surgery on T2 DM and metabolic syndrome and its components.Furthermore,we evaluated potential value of some predicting factors such as visceral fat and bile acids in T2 DM remission short term after the operation.Section 1.A Clinical Effective Study of Metabilic Surgery on Chinese Obese Patients with Type 2 DiabetesObjective: Metabolic surgery is currently the most effective treatment for substantial and sustained weight loss in C hinese obese individuals with type 2 diabetes(T2DM).We aim to determine the efficacy of surgical treatment on diabetes remission in a short term after the surgery.Methods: A total of consecutive 262 obese T2 DM individuals who underwent metabolic surgery from February 2011 to January 2016 were enrolled in the study.All patients were subjected to follow-up controls with anthropometric and metabolic indices at 1,3,6,12 and 24 months after surgery.Glucose disposition indexes was evaluated.Diabetes remission was defined according to the criteria established by China Guideline for Type 2 Diabetes(2013).Results: Of the 262 individuals who underwent metabolic surgery,117(44.7%)was female,222(84.7%)were underwent RYGB and 40(15.3%)were sleeve.The mean age was 45.8±12.9 years and average duration was 7.0±5.2 years.Remission of T2 DM in 77.2% of all the patients one year after the surgery and 63.0% two years after the surgery.Glucose disposition ability was greatly improved after the surgery,especially 6 to 12 months postoperatively.Subgroup analysis showed that RYGB and sleeve have similar effects on diabetes remission one year after the surgery(76.6% and 77.8%,respectively).Conclusion: Both RYGB and sleeve result in significant weight loss and remission of T2 DM in Chinese obese patients in a short term.Longer follow-up is required for better evaluation.Section 2.Metabolic Syndrome after Laparoscopic Roux-en-Y gastric bypass in Chinese Obese Patients with Type 2 DiabetesObjective: Roux-en-Y gastric bypass(RYGB)surgery is currently the most effective treatment for substantial and sustained weight loss in morbidly obese individuals.We aim to determine the prevalence in C hinese obese patients with type 2 diabetes(T2DM)and the efficacy of surgical treatment of the metabolic syndrome(Met S)and its components with a control group in medical therapy.Furthermore,we evaluate potential predicting factors for the Met S remission.Methods: A total of 121 obese T2 DM individuals who underwent bariatric surgery and 93 non-operative obese patients with T2 DM were enrolled in the study.Met S was defined according to the criteria established by the C hinese Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults(JCDCG)(central obesity,increased triglycerides,low high density lipoprotein,increased blood pressure,increased plasma glucose,or previously diagnosed DM).We determined the change in Met S and the prevalence of its components,and performed logistic regression models to evaluate predictors of Met S remission.Results: One year after bariatric surgery,all Met S components improved in the surgical group and medication use decreased.The medical therapy group had mild improvements in Met S components.O f the surgical group,Met S prevalence decreased from 108 patients(83.3%)to 20(16.5%),and from 88 patients(94.6%)to 76(81.7%)in the control group.Multiple logistic regression analyses further indicated that a shorter diabetes duration and higher percent excess weight loss(%EWL)were associated with a greater chance of Met S remission after surgery.The odd ratios were 0.85(95%CI,0.76 to 0.95),1.80(95%CI,1.27 to 2.96),respectively.Conclusion: Bariatric surgery induces considerable and persistent improvement in Met S prevalence in C hinese obese patients with T2 DM.Diabetes duration and %EWL might act as potential prognostic markers in predicting the Met S reversibility,after adjusted for gender,age,waist circumference and VFA.Section 3.Study on fat distribution and Effects Prediction for Roux-en-Y gastric bypass surgery in Chinese obese patients with Type 2 DiabetesObjective: Metabolic surgery has been proposed for inadequately controlled type 2 diabetes mellitus(T2DM)in association with obesity.However,prediction of successful T2 DM remission after surgery has not been clearly studied in Chinese patients.Predicting the outcome in those with T2 DM after metabolic surgery may help in patient selection.Methods: A retrospective review of prospectively collected data of 68 ethnic Chinese with mean BMI 31.5kg/m2 and T2 DM were examined for the metabolic outcomes at 1 year after Roux-en-Y gastric bypass(RYGB).Visceral and abdominal subcutaneous fat areas were assessed using magnetic resonance imaging before and 1 year after RYGB.Remission was defined as a glycated hemoglobin(Hb A1c)<6.5% and no medications at one year.Binary logistic regression analysis was used to identify predictors.Results: At 1 year after surgery,the BMI in the study group decreased from 31.5±3.6 to 24.5±2.5kg/m2.Remission was achieved in 50 subjects(73.5%)at 1 year.Compared with patients in the non-remission group,patients in the remission group had a shorter duration of diabetes,lower preoperative Hb A1 C level,higher fasting C-peptide level and more visceral fat area(VFA).Preoperative body mass index(BMI)and waist circumference did not differ between the two groups.Logistic analysis confirmed duration,VFA and fasting C-peotide are clinical predictors of diabetes remission.Conclusion: The metabolic improvement in T2 DM after RYGB in the mildly obese is greater with a shorter duration of diabetes,higher fasting C-peptide.Those who have more visceral adiposity may obtain greater benefit from RYGB.Section 4.Study on the Relationship between Serum Bile Acids Levels and Effects Prediction for Roux-en-Y Gastric Bypass Surgery in Chinese Obese Patients with Type 2 DiabetesObjective: Roux-en-Y gastric bypass(RYGB)has been proposed as an effective treatment for obesity-related type 2 diabetes(T2DM)patients,but the operative mechanism is not completely understood.Bile acids(BAs)act as hormones and are involved in the modification of metabolic homeostasis after RYGB.In this study,we aimed to test the hypothesis that individual or a group of BAs may have potential value to predict the therapeutic outcome after RYGB.Methods: We applied a targeted metabolomics approach to quantitatively measure 26 serum BAs in a total of 365 subjects from two independent studies,using ultra-performance liquid chromatography triple quadruple mass spectrometry.The relative proportion of each BA in total BAs was calculated to minimize the large variations detected among individuals.First,we evaluated the changes of BAs proportions within 12 months for 38 obese patients who were diagnosed with T2 DM and received RYGB,and examined their role in predicting the diabetes remission 2 years after the surgery.Second,the BA proportions were compared among different metabolic phenotypes of individuals from a cross-sectional study(n=327),including 126 lean subjects with normal glucose tolerance(NGT),76 overweight NGT(OW),48 obese N GT(OB),44 overweight subjects diagnosed with T2DM(OW/DM)and 33 obese subjects with T2DM(OB/DM)subjects.Results: In the metabolic surgery follow up study,RYGB was effective in the reduction of body weight in both remission and non-remission groups.The reductions of BMI in both groups were 7.34±2.10kg/m2 and 6.31±2.38kg/m2 respectively(p=0.14).Patients in the remission group had shorter duration of diabetes,lower glycated haemoglobin(Hb A1c),higher C-peptide and C DCA proportion(CDCA %)at baseline compared with the non-remission group.Multiple logistic regression analysis further indicated that larger CDCA % and shorter duration were associated with higher possibility to achieve diabetes remission after surgery.The odd ratios were 0.19(95%CI,0.05 to 0.74),1.77(95%CI,1.13 to 2.76)respectively after adjusted for age,gender and BMI.The areas under ROC of duration,CDCA %,Hb A1 c and C peptide were 0.78,0.77,0.75 and 0.74 respectively.In the cross-sectional study,C DCA% was significantly higher in obese individuals with T2 DM than the NGT group.Correlation analysis showed CDCA% was positively correlated with BMI,Hb A1 c,TG,LDL-c,and negatively correlated with HDL-c and T2 DM duration.Conclusion: CDC A might act as a new potential predictor of diabetes remission 2 years after RYGB.Those diabetic patients with higher C DCA% may benefit more from the RYGB.Its biological mechanism warrants further investigation. |
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