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Ke Z, Lu Z, Li F, Zhao Q, Jiang X, Hu Z, Sun F, He Z, Tang Y, Li Q, van Oostendorp S, Chen X, He Q, Wang Y, Zhu Z, Tong W. Gut microbiota alterations induced by Roux-en-Y gastric bypass result in glucose-lowering by enhancing intestinal glucose excretion. Gut Microbes 2025; 17:2473519. [PMID: 40028693 PMCID: PMC11881838 DOI: 10.1080/19490976.2025.2473519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 01/26/2025] [Accepted: 02/21/2025] [Indexed: 03/05/2025] Open
Abstract
Roux-en-Y gastric bypass (RYGB) results in glucose-lowering in patients with type 2 diabetes mellitus (T2DM) and may be associated with increased intestinal glucose excretion. However, the contribution of intestinal glucose excretion to glycemic control after RYGB and its underlying mechanisms are not fully elucidated. Here, we confirmed that intestinal glucose excretion significantly increased in obese rats after RYGB, which was negatively correlated with postoperative blood glucose levels. Moreover, we also found that the contribution of Biliopancreatic limb length, an important factor affecting glycemic control after RYGB, to the improvement of glucose metabolism after RYGB attributed to the enhancement of intestinal glucose excretion. Subsequently, we further determined through multiple animal models that intestinal glucose excretion is physiological rather than pathological and plays a crucial role in maintaining glucose homeostasis in the body. Finally, we employed germ-free mice colonized with fecal samples from patients and rats to demonstrate that enhanced intestinal glucose excretion after RYGB is directly modulated by the surgery-induced changes in the gut microbiota. These results indicated that the gut microbiota plays a direct causal role in the hypoglycemic effect of RYGB by promoting intestinal glucose excretion, which may provide new insights for developing gut microbiota-based therapies for T2DM.
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Affiliation(s)
- Zhigang Ke
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Zongshi Lu
- Department of Hypertension and Endocrinology, Daping Hospital, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Army Medical University, Chongqing, China
| | - Fan Li
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Qingyuan Zhao
- Department of Laboratory Animal Science, College of Basic Medical Sciences, Army Medical University, Chongqing, China
| | - Xianhong Jiang
- Department of Laboratory Animal Science, College of Basic Medical Sciences, Army Medical University, Chongqing, China
| | - Zhihao Hu
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Fang Sun
- Department of Hypertension and Endocrinology, Daping Hospital, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Army Medical University, Chongqing, China
| | - Zongcheng He
- Department of Digestive Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Yi Tang
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Qing Li
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Stefan van Oostendorp
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Xiao Chen
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Qiuyue He
- Department of Laboratory Animal Science, College of Basic Medical Sciences, Army Medical University, Chongqing, China
| | - Yong Wang
- Department of Laboratory Animal Science, College of Basic Medical Sciences, Army Medical University, Chongqing, China
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Daping Hospital, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Army Medical University, Chongqing, China
| | - Weidong Tong
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
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Retnakaran R, Pu J, Emery A, Kramer CK, Zinman B. The coordinated changes in insulin sensitivity and insulin secretion associated with the remission of type 2 diabetes following short-term insulin therapy. Diabetes Obes Metab 2025; 27:3546-3548. [PMID: 40045748 DOI: 10.1111/dom.16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 02/19/2025] [Accepted: 02/22/2025] [Indexed: 05/04/2025]
Affiliation(s)
- Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jiajie Pu
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Alexandra Emery
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Caroline K Kramer
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Bernard Zinman
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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Morieri ML, Rigato M, Frison V, D'Ambrosio M, Sartore G, Avogaro A, Fadini GP. Early weight loss, diabetes remission and long-term trajectory after diagnosis of type 2 diabetes: a retrospective study. Diabetologia 2025; 68:1115-1125. [PMID: 40119903 PMCID: PMC12069414 DOI: 10.1007/s00125-025-06402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 02/06/2025] [Indexed: 03/25/2025]
Abstract
AIMS/HYPOTHESIS Weight loss can improve glycaemic management in individuals with type 2 diabetes, but its long-term effects on remission, cardiovascular risk factors and complications remain unclear. We investigated clinical outcomes following non-interventional ≥10% body weight loss in people with newly diagnosed type 2 diabetes in a routine care setting. METHODS We retrospectively analysed two cohorts of people with newly diagnosed type 2 diabetes. After exclusions, cohort 1 included 1934 individuals followed for up to 25 years; cohort 2 comprised 13,277 individuals followed for up to 10 years. Participants were categorised into two groups based on whether or not they lost at least 10% body weight. In a sensitivity analysis, a group of participants with intermediate weight loss (5% to <10%) was also considered. Outcomes included HbA1c, diabetes remission, cardiovascular parameters and chronic complications. RESULTS Participants (58% male) had a mean age of 62 years and a mean diabetes duration of <2 years at inclusion; mean baseline HbA1c was 57-64 mmol/mol (7.4-8.0%) and mean BMI was ~30 kg/m2. Weight loss ≥10% was obtained in 15.9% (n=308) of participants in cohort 1 and in 8.8% (n=1167) in cohort 2. In cohort 1, weight loss ≥10% was associated with a sustained reduction in HbA1c (mean difference 2.1 mmol/mol; 0.19%) and a higher remission rate than in the <10% weight loss group (20.2% vs 5.5%; HR 4.2). These findings were confirmed in cohort 2, with remission rates of 13.2% and 4.1% (HR 2.6) in the ≥10% and <10% weight loss groups, respectively. Weight loss ≥10% improved systolic BP and HDL-cholesterol and triglyceride levels. Participants with weight loss of 5% to <10% (28.2% in cohort 1 and 17.4% in cohort 2) had marginal improvements in HbA1c, lipids and remission rates compared with participants with weight loss <5%, and such results were inferior to those achieved with weight loss ≥10%. In cohort 1, compared with weight loss <5% (reference), the HR for remission was 5.2 with weight loss ≥10% vs 1.7 with weight loss 5% to <10%. Weight loss ≥10% was not associated with a reduced incidence of complications. On the other hand, remission was independently associated with a significantly lower rate of new-onset microangiopathy (adjusted HR 0.84; 95% CI 0.73, 0.97; p=0.019). CONCLUSIONS/INTERPRETATION Early weight loss of ≥10% in type 2 diabetes was associated with sustained glycaemic improvements, increasing by three to four times the rates of diabetes remission. Remission, in turn, more than weight loss was associated with a reduced risk of complications.
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Affiliation(s)
| | - Mauro Rigato
- Department of Medicine, University of Padova, Padua, Italy
| | - Vera Frison
- Unit of Diabetology, Cittadella Hospital, ULSS6 Euganea, Cittadella, Italy
| | - Michele D'Ambrosio
- Unit of Diabetology, Ospedali Riuniti Padova Sud, ULSS6 Euganea, Monselice, Italy
| | - Giovanni Sartore
- Department of Medicine, University of Padova, Padua, Italy
- Unit of Diabetology, Ospedale dei Colli, ULSS6 Euganea, Padua, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padua, Italy
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Boughanem H, de Larriva APA, Camargo A, Torres-Peña JD, Ojeda-Rodriguez A, Alcala-Diaz JF, Romero-Cabrera JL, Rangel-Zuñiga OA, Rodríguez-Cantalejo F, Soehnlein O, Macias-Gonzalez M, Tinahones FJ, Perez-Martinez P, Delgado-Lista J, López-Miranda J. Decreased Neutrophils Are Associated With Reduced Risk of Type 2 Diabetes Incidence: Results From the CORDIOPREV Study. J Clin Endocrinol Metab 2025; 110:1550-1558. [PMID: 39470387 DOI: 10.1210/clinem/dgae736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 09/30/2024] [Accepted: 10/25/2024] [Indexed: 10/30/2024]
Abstract
CONTEXT Numerous studies have reported an association between neutrophils and type 2 diabetes mellitus (T2DM), although this relationship remains unclear. OBJECTIVE To investigate the interaction of neutrophils and a dietary intervention on T2DM incidence after 60 months of follow-up. METHODS A comprehensive analysis was conducted on the framework of the CORDIOPREV study, which included 462 patients without T2DM at the beginning of the study, randomly assigned to either a Mediterranean or a low-fat diet; 107 developed T2DM. Absolute neutrophil counts and neutrophil-related ratios were measured. RESULTS Kaplan-Meier curves showed that the lowest tertile of basal neutrophils was associated with a reduced likelihood of T2DM incidence when compared to the middle (hazard ratio [HR] = 0.499 [95% CI, 0.287-0.866]) and the highest tertiles (HR = 0.442 [95% CI, 0.255-0.768]) in the overall population, after adjusting for clinical variables. This association only remained significant in patients who followed a Mediterranean diet when comparing the lowest to the middle (HR = 0.423 [95% CI, 0.213-0.842]) and the highest tertiles (HR = 0.371 [95% CI, 0.182-0.762]). The predictive capacity yielded an AUC of 0.711 (95% CI, 0.652-0.769), with neutrophils being the most important variable in the in the model. Decrease in neutrophils over the 60 months was associated with increased insulin sensitivity index (R = -0.31; P = .019), particularly in patients who followed the Mediterranean diet. CONCLUSION These findings suggest that monitoring neutrophils can help prevent the development of T2DM, as a reduction in neutrophil counts could be associated with improved insulin sensitivity. Following a Mediterranean diet might be a potential strategy to reduce the incidence of T2DM by lowering neutrophil levels. Further research is necessary to gain a deeper understanding regarding this mechanism.
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Affiliation(s)
- Hatim Boughanem
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, 14004 Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Antonio Pablo Arenas de Larriva
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, 14004 Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Antonio Camargo
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, 14004 Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - José D Torres-Peña
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, 14004 Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana Ojeda-Rodriguez
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, 14004 Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan F Alcala-Diaz
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, 14004 Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan L Romero-Cabrera
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, 14004 Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Oriol Alberto Rangel-Zuñiga
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, 14004 Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | - Oliver Soehnlein
- Institute of Experimental Pathology (ExPat), Center of Molecular Biology of Inflammation (ZMBE), University of Münster, 48149 Münster, Germany
| | - Manuel Macias-Gonzalez
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Malaga, Spain
| | - Francisco J Tinahones
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Malaga, Spain
| | - Pablo Perez-Martinez
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, 14004 Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, 14004 Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - José López-Miranda
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, 14004 Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Queiroz S, Gadelha JG, Husain N, Gutu CS. Effect of Gastric Bypass vs Sleeve Gastrectomy on Remission of Type 2 Diabetes Mellitus Among Patients with Severe Obesity: A Meta-Analysis. Obes Surg 2025:10.1007/s11695-025-07858-w. [PMID: 40377815 DOI: 10.1007/s11695-025-07858-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 03/19/2025] [Accepted: 04/04/2025] [Indexed: 05/18/2025]
Abstract
BACKGROUND Obesity and type 2 diabetes mellitus (T2DM) are global health crises, with bariatric surgery emerging as a key intervention. However, the comparative efficacy of Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) in achieving diabetes remission remains debated. METHODS This PRISMA-compliant meta-analysis included three randomized controlled trials (RCTs, n = 613 patients) comparing RYGB and SG in adults with severe obesity (BMI ≥30 kg/m²) and T2DM. PRIMARY OUTCOME diabetes remission (HbA1c 6.0%). Risk of bias was assessed via Cochrane RoB-2 tool; statistical analysis used fixed-effect models (I²=0%). RESULTS RYGB demonstrated superior diabetes remission rates vs. SG (OR 2.77, 95% CI 1.83-4.20, p0.001), with no heterogeneity. Subgroup analyses confirmed consistency across studies. Mean follow-up was ≤5 years; baseline demographics were comparable (mean age 46.2 years, 53.4% male). CONCLUSION RYGB significantly outperforms SG in achieving T2DM remission, likely due to its combined restrictivemalabsorptive mechanisms and metabolic hormonal effects. These findings support RYGB as the preferred surgical option for obese patients with T2DM, though long-term studies are needed to assess durability.
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Affiliation(s)
| | | | - Noor Husain
- Indira Gandhi Institute of Medical Sciences, Patna, India
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Liu Y, Gang XK, Gao Y, Wang YX, Wang GX. Global status and trends in type 2 diabetes remission from 2002 to 2022: A bibliometric and visual analysis. Medicine (Baltimore) 2025; 104:e42257. [PMID: 40324218 PMCID: PMC12055079 DOI: 10.1097/md.0000000000042257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 11/23/2024] [Accepted: 11/28/2024] [Indexed: 05/07/2025] Open
Abstract
Type 2 diabetes mellitus (T2DM) is estimated to impact 693 million individuals globally by 2045. Diabetes remission has the potential to slow disease progression, alleviate psychological burdens, minimize complications, and improve quality of life. We aimed to perform a bibliometric analysis of research on T2DM remission. We searched the Web of Science (WoS) database to identify relevant publications on T2DM remission during 2002 to 2022. Research trends and hotspots in T2DM remission were analyzed using Bibliometrix R and CiteSpace. The analysis considered various factors such as publication year, authors, journal, institution, country/region, themes, thematic evolution, keywords, and keyword bursts. The WoS search yielded 2254 articles. The annual scientific output has consistently increased. Lee was the most prolific author (48 papers). Obesity surgery was the leading journal (296 publications), while diabetes care had the highest h_index (43). The University of Copenhagen was the most active institution (116 papers). The most productive countries were the US (476), China (347), the UK (180), Italy (121), and Japan (90). The top 3 keywords were "bariatric surgery," "weight loss," and "remission." From 2013 to 2015, the usage of the term "medical therapy" significantly surged, lasting for 3 years. The term "GLP-I receptor agonists" also had a lasting burst. In the past 5 years, "weight loss" and "low-calorie diets" have emerged as prominent areas of research. This study analyzed the research trends and key factors in the field of type 2 diabetes mitigation through bibliometrics, providing important data support and a basis for decision-making for future research and public health policies.
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Affiliation(s)
- Yang Liu
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiao-Kun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yuan Gao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ying-Xuan Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Gui-Xia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin Province, China
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Taylor R. Aetiology of type 2 diabetes: an experimental medicine odyssey. Diabetologia 2025:10.1007/s00125-025-06428-0. [PMID: 40316731 DOI: 10.1007/s00125-025-06428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 02/26/2025] [Indexed: 05/04/2025]
Abstract
This review describes a prolonged research endeavour to test the twin cycle hypothesis that type 2 diabetes is caused by fat-induced dysfunction of the liver and pancreas, guided by the happenstance of clinical practice. Testing of the personal fat threshold hypothesis, that individuals exhibit different levels of tolerance to intra-organ fat accumulation, is also described. Both hypotheses predict that type 2 diabetes is potentially reversible by weight loss. The results of the Counterpoint study supported the twin cycle hypothesis, leading to a second study which determined that short-duration diabetes was more likely to remit following the 10-15 kg weight loss. It also confirmed that remission was durable over 6 months on an isoenergetic, normal diet. Subsequently, it was shown that weight loss caused an immediate decrease of pancreas fat only in people with type 2 diabetes and also that postprandial incretin spikes after bariatric surgery had no role in normalising fasting plasma glucose. DiRECT, a 2 year randomised controlled study, demonstrated clinical utility, observing functional beta cell capacity to return almost to normal over 12 months. A small group of participants regained weight and redeveloped type 2 diabetes, allowing observation that the underlying pathophysiological mechanisms during onset of diabetes were as postulated by the twin cycle hypothesis. Major clinical benefit was demonstrated after a further 3 year follow-up in routine care, halving the incidence of serious adverse effect compared with the standard treatment control group. In answer to the question of whether individuals have a personal fat threshold for tolerance of fat, stepwise weight loss in people with type 2 diabetes and BMI in the range 21-27 kg/m2 resulted in remission in 70%, with a wide range of fat thresholds. Type 2 diabetes can be regarded as a condition of homogenous aetiology in genetically heterogenous individuals.
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Affiliation(s)
- Roy Taylor
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
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Campbell K, Ashton N, Peddie MC, Ma'ia'i K, Camp J, Mann J, Reynolds AN. A DiRECT approach to weight loss in a culturally diverse, low-income population: Pilot randomised controlled trial and meta-analysis of similar interventions. Diabetes Obes Metab 2025; 27:2442-2453. [PMID: 39935104 PMCID: PMC11964991 DOI: 10.1111/dom.16240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Revised: 01/15/2025] [Accepted: 01/24/2025] [Indexed: 02/13/2025]
Abstract
AIMS To consider an intensive lifestyle intervention for weight loss in type 2 diabetes or prediabetes when delivered within a primary care service catering to indigenous (Māori), Pacific, refugee, and low-income clientele. MATERIALS AND METHODS Adults with obesity, type 2 diabetes or prediabetes, and a desire to lose weight were randomised to dietitian-supported usual care or the Diabetes Remission Clinical Trial (DiRECT)-type intervention (3 months of total diet replacement followed by 9 months of food reintroduction and supported weight loss maintenance). Both interventions included equal dietetic support delivered within primary care. Primary outcome was weight loss at 3 and 12 months. We performed random-effects meta-analysis of body weight of existing DiRECT-type interventions. RESULTS Forty participants were randomised to the dietitian-led DiRECT-type intervention or dietitian-supported usual care. At 3 months, weight loss among DiRECT-type intervention participants was -6.1 kg (95% CI -10.2, -2.0) greater than with dietetic support. At 12 months, this difference decreased to -3.8 kg (-7.6, -0.1) due to gradual weight loss with dietitian-supported usual care, not weight regain in DiRECT. Meta-analyses indicated -8.5 kg (-11.1, -5.9) and -6.0 kg (-8.4, -3.5) greater weight loss for DiRECT-type interventions than usual diabetes care (with or without dietary advice) at 3 and 12 months. CONCLUSIONS In this pilot effectiveness trial, the DiRECT-type intervention generated clinically relevant and greater weight loss than dietitian-supported usual care at 3 and 12 months. These results align with the effect sizes generated by meta-analyses of existing DiRECT-type interventions, demonstrating the potential use of DiRECT-type approaches across a much broader spectrum of the population than previously considered including those with both type 2 and prediabetes. ACTRN12622000151730.
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Affiliation(s)
- Kate Campbell
- Department of MedicineUniversity of OtagoDunedinNew Zealand
- Department of Human NutritionUniversity of OtagoDunedinNew Zealand
- Edgar Diabetes and Obesity Research CentreUniversity of OtagoDunedinNew Zealand
| | | | | | - Kim Ma'ia'i
- Te Kāika Health, Medical CentreDunedinNew Zealand
| | - Justine Camp
- Department of MedicineUniversity of OtagoDunedinNew Zealand
- Edgar Diabetes and Obesity Research CentreUniversity of OtagoDunedinNew Zealand
| | - Jim Mann
- Department of MedicineUniversity of OtagoDunedinNew Zealand
- Edgar Diabetes and Obesity Research CentreUniversity of OtagoDunedinNew Zealand
| | - Andrew N. Reynolds
- Department of MedicineUniversity of OtagoDunedinNew Zealand
- Edgar Diabetes and Obesity Research CentreUniversity of OtagoDunedinNew Zealand
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Battelino T, Lalic N, Hussain S, Ceriello A, Klobucar S, Davies SJ, Topsever P, Heverly J, Ulivi F, Brady K, Tankova T, Galhardo J, Tagkalos K, Werson E, Mathieu C, Schwarz P. The use of continuous glucose monitoring in people living with obesity, intermediate hyperglycemia or type 2 diabetes. Diabetes Res Clin Pract 2025; 223:112111. [PMID: 40118193 DOI: 10.1016/j.diabres.2025.112111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 03/12/2025] [Accepted: 03/17/2025] [Indexed: 03/23/2025]
Abstract
A global trend towards increased obesity, intermediate hyperglycemia (previously termed prediabetes) and type 2 diabetes, has prompted a range of international initiatives to proactively raise awareness and provide action-driven recommendations to prevent and manage these linked disease states. One approach, that has shown success in managing people already diagnosed with type 2 diabetes mellitus, is to use continuous glucose monitoring (CGM) devices to help them manage their chronic condition through understanding and treating their daily glucose fluctuations, in assocation with glucose-lowering medications, including insulin. However, much of the burden of type 2 diabetes mellitus is founded in the delayed detection both of type 2 diabetes mellitus itself, and the intermediate hyperglycemia that precedes it. In this review, we provide evidence that using CGM technology in people at-risk of intermediate hyperglycemia or type 2 diabetes mellitus can significantly improve the rate and timing of detection of dysglycemia. Earlier detection allows intervention, including through continued use of CGM to guide changes to diet and lifestyle, that can delay or prevent harmful progression of early dysglycemia. Although further research is needed to fully understand the cost-effectiveness of this intervention in people at-risk or with early dysglycemia, the proposition for use of CGM technology is clear.
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Affiliation(s)
- Tadej Battelino
- University Medical Center Ljubljana, and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.
| | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, Center for Diabetes and Lipid Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Sufyan Hussain
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, UK; Department of Diabetes and Endocrinology, Guy's & St Thomas' NHS Foundation Trust, London, UK; Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | | | - Sanja Klobucar
- Department for Endocrinology, Diabetes and Metabolism, University Hospital Centre Rijeka, School of Medicine, University of Rijeka, Croatia
| | | | - Pinar Topsever
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Family Medicine, Istanbul, Turkiye
| | - Julie Heverly
- diaTribe Foundation, San Francisco, CA, United States
| | | | - Kevin Brady
- diabetes Geneva, Avenue Cardinal-Mermillod 36, Carouge, Switzerland
| | - Tsvetalana Tankova
- Department of Endocrinology, Medical University - Sofia, Sofia, Bulgaria
| | | | | | | | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, Louvain, Belgium
| | - Peter Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus at the Technische Universität/TU Dresden, Dresden, Germany; Paul Langerhans Institute Dresden of Helmholtz Zentrum München at University Hospital and Faculty of Medicine, TU Dresden 01307 Dresden, Germany
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10
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Shin S, Kim HY, Kim SY, Kim J. Clinical Characteristics of Korean Patients with Youth-Onset Type 2 Diabetes Mellitus in Remission. J Obes Metab Syndr 2025; 34:158-165. [PMID: 40194890 PMCID: PMC12067001 DOI: 10.7570/jomes24042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 01/12/2025] [Accepted: 03/26/2025] [Indexed: 04/09/2025] Open
Abstract
Background Improving β-cell function can lead to remission in some patients with type 2 diabetes mellitus (T2DM). However, research on pharmacotherapy-induced remission in youth-onset T2DM remains scarce. Our study aimed to identify the clinical characteristics of pediatric patients who experience remission. Methods We retrospectively reviewed 88 pediatric patients with T2DM followed for at least 1 year at Seoul National University Bundang Hospital between 2013 and 2023. Remission was defined as a glycosylated hemoglobin (HbA1c) level less than 6.5% for at least 3 months after ceasing glucose-lowering pharmacotherapy. Results Among 88 patients (60 males, 68.2%) diagnosed at an average age of 14.4±2.1 years, 19 patients (21.6%) achieved remission after a median duration of 1.4 years. The remission group had a larger proportion of males (89.5% vs. 62.3%, P=0.024) and a lower urinary albumin-to-creatinine ratio (ACR) at diagnosis (P=0.011). They also showed lower HbA1c levels at 1 year and more significant changes in HbA1c and body mass index (all P<0.05). Higher urinary ACR levels correlated with a longer duration to achieve remission (hazard ratio, 0.928; P=0.013). In three of the 19 remission patients (15.8%), recurrence occurred after a median of 1.5 years. Conclusion Among Korean youth with T2DM, 21.6% achieved remission after a median duration of 1.4 years. Those who experienced remission were predominantly male, had lower ACR at diagnosis, and had significant weight loss within the first year. Further investigation into the factors influencing remission and long-term outcomes is essential.
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Affiliation(s)
- Sohyun Shin
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hwa Young Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Se Young Kim
- Department of Pediatrics, Bundang Jesaeng Hospital, Daejin Medical Center, Seongnam, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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11
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Zhang Z, Jiang T. One-Year Outcomes of SADI-S in Chinese Patients with Type 2 Diabetes and BMI < 35 kg/m 2: A Single-Center Retrospective Study. Obes Surg 2025:10.1007/s11695-025-07872-y. [PMID: 40281251 DOI: 10.1007/s11695-025-07872-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 03/28/2025] [Accepted: 04/10/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND There is limited evidence on the efficacy and safety of single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in treating type 2 diabetes mellitus (T2DM) in patients with body mass index (BMI) < 35 kg/m2. METHODS This study included clinical data from 22 T2DM patients with BMI < 35 kg/m2 who received SADI-S treatment. Changes in diabetes-related indicators, weight-related indicators, and patient nutritional outcomes were analyzed. RESULTS SADI-S was successfully performed in all 22 cases, with no conversions to laparotomy or resulting deaths. The incidence of surgical complications was 4.54% (1/22). One-year postsurgery, there was a significant decrease in BMI from 32.42 ± 2.18 to 22.11 ± 1.86 kg/m2 (P < 0.05) and a significant decrease in mean HbA1c from 8.76 ± 1.74 to 5.25 ± 0.76% (P < 0.05). The %EWL and %TWL were 145.78 ± 35.97% and 31.60 ± 6.34% respectively at 1 year. The remission rate for T2DM was 94.7% (18/19) at 1 year. Following SADI-S, the incidence rates of zinc deficiency and vitamin D deficiency at 1 year were 38.46% (5/13) and 30.77% (4/13), respectively, significantly higher than presurgery. CONCLUSIONS SADI-S is considered an efficient, safe, and feasible surgical approach for patients with T2DM and a BMI < 35 kg/m2. Nevertheless, additional research, including potentially multi-center collaborative studies, is warranted to assess the procedure's long-term outcomes.
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Affiliation(s)
- Zheng Zhang
- China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tao Jiang
- China-Japan Union Hospital of Jilin University, Changchun, China.
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12
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Grinlinton ME, Elliott D, Pearless LA, Booth MWC. Banded One Anastomosis Gastric Bypass: 15 Year Results from a Single Centre. Obes Surg 2025:10.1007/s11695-025-07876-8. [PMID: 40249418 DOI: 10.1007/s11695-025-07876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 03/14/2025] [Accepted: 04/10/2025] [Indexed: 04/19/2025]
Abstract
BACKGROUND Banded one anastomosis gastric bypass (BOAGB) is an efficacious surgical option for patients with obesity. OAGB has a high percentage excess weight loss reported in the literature, and the addition of a silastic ring (SR) otherwise known as a band, helps to reduce recurrent weight gain. METHODS 156 patients from a single centre between 2005-2008 underwent a BOAGB. A questionnaire, blood test results and electronic records were utilised at 15 years post-operatively to identify patient outcomes. RESULTS At 15 years, the average percentage excess weight loss (%EWL) was 82.0%, the average percentage total weight loss (%TWL) was 35.9%, and the average body mass index (BMI) had reduced from 46.3 kg/m2 to 29.7 kg/m2. 106/114 (93.0%) of patients had adequate weight loss at 15 years. 27/114 (23.7%) of patients had recurrent weight gain at 15 years. Antihypertensives, lipid lowering therapy and hypoglycaemic medications had all reduced, and proton pump inhibitor medications had increased. There were 11 (7.1%) deaths by 15 years, and none were directly related to the initial operation. Silastic rings were removed in 12 patients (7.7%). 21 (13.5%) patients had a conversion to a Roux-en-Y gastric bypass over 15 years, of which 14 (9.0%) were due to reflux. There were no conversions for malnutrition. Patient satisfaction was high, with an average Likert satisfaction score of 8.4. CONCLUSIONS BOAGB continues to show good results as an effective operation at 15 years, with a high %EWL and %TWL, low conversion rate, and significant reduction in medication use for hypertension, hyperlipidaemia, and T2D. There was an increase in proton pump inhibitor use at 15 years. The operation is durable and weight loss remains excellent. The addition of a SR is effective in reducing long-term recurrent weight gain.
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13
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Zhang N, Zhou B, Wang H, Xue X, Huang Y, Wang S, Wang Z, Niu W, Liu B, Nie Y, Li Z, Zhang L, Wang P, Chou S, Yao L, Ran S, Lv J, Liu G, Li G, Meng H. Predictors of diabetes remission after bariatric surgery in patients with type 2 diabetes mellitus duration ≥ 10 years: A retrospective cohort study. Diabetes Res Clin Pract 2025; 224:112164. [PMID: 40209896 DOI: 10.1016/j.diabres.2025.112164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 03/19/2025] [Accepted: 04/06/2025] [Indexed: 04/12/2025]
Abstract
OBJECTIVE Patients with type 2 diabetes mellitus (T2DM) duration ≥ 10 years often have significant β-cell failure. This study aimed to explore predictors of diabetes remission after bariatric surgery in these patients. METHODS Patients with T2DM duration ≥ 10 years who underwent bariatric surgery were retrospective included and followed up. Remission of diabetes was defined as an HbA1c < 6.5 % (48 mmol/mol) at least 3 months after the discontinuation of hypoglycemic drugs. An intravenous glucose tolerance test (IVGTT) was performed in patients with diabetes remission. RESULTS 203 patients with T2DM duration ≥ 10 years were included, 59.6 % were treated with insulin before bariatric surgery. One-, two- and three-year post-surgery remission rates were 65.6 %, 53.8 % and 41.9 %, respectively (∼10 % decrease/year). Cox regression analysis revealed that the odds of remission at one-year post-bariatric surgery were most strongly associated with β-cell function (HR 1.20, 95 % CI 1.03-1.40) and percentage of total weight loss (%TWL) (HR 1.04, 95 % CI 1.01-1.07). The first-phase insulin secretion peak was approximately 5-8 folds of the fasting insulin level in 50 patients with diabetes remission. CONCLUSIONS %TWL and β-cell function are significantly associated with diabetes remission after bariatric surgery in long-duration T2DM patients, with restored first-phase insulin secretion still observed.
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Affiliation(s)
- Nianrong Zhang
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Biao Zhou
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Hao Wang
- Xiangya School of Medicine, Central South University, Changsha 410013 Hunan, China.
| | - Xiaobin Xue
- Graduate School, Peking Union Medical College, Beijing 100730, China.
| | - Yishan Huang
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Siqi Wang
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Zhe Wang
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Wenquan Niu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing 100020, China.
| | - Baoyin Liu
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Yuntao Nie
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Zhengqi Li
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Lei Zhang
- Department of Oncology, Sinopharm Tongmei General Hospital, Datong 037000 Shanxi, China.
| | - Pengpeng Wang
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Sai Chou
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Lin Yao
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Shuman Ran
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Jinyong Lv
- Department of General Surgery, OASIS International Hospital, Beijing 100029, China.
| | - Genzheng Liu
- Graduate School, Peking Union Medical College, Beijing 100730, China.
| | - Guangwei Li
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Hua Meng
- Department of General Surgery＆Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China.
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14
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Colagiuri S, Ceriello A. 5. Weight control in type 2 diabetes management. Diabetes Res Clin Pract 2025:112149. [PMID: 40204547 DOI: 10.1016/j.diabres.2025.112149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
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15
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Norhammar A, Ritsinger V. The recent renewed interest among cardiologists in detecting and preventing diabetes is welcomed. Eur Heart J 2025; 46:1332-1334. [PMID: 39913237 PMCID: PMC11973563 DOI: 10.1093/eurheartj/ehae833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2025] Open
Affiliation(s)
- Anna Norhammar
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, 17176 Stockholm, Sweden
- Capio S:t Görans Hospital, Stockholm, Sweden
| | - Viveca Ritsinger
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, 17176 Stockholm, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
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16
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Sample JW, Cottam D, Lind R, Surve A, Ghanem M, Medlin WS, Laplante S, Hage K, Kee C, Belnap L, Mooers B, Cottam T, Teixeira AF, Ghanem OM. Single-anastomosis duodenal-ileal bypass with sleeve gastrectomy for diabetes: predictors of remission and metabolic outcomes in a multicenter study. Surg Obes Relat Dis 2025:S1550-7289(25)00137-6. [PMID: 40307083 DOI: 10.1016/j.soard.2025.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 02/10/2025] [Accepted: 03/21/2025] [Indexed: 05/02/2025]
Abstract
BACKGROUND The single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) combines the restrictive aspects of a sleeve gastrectomy (SG) with the hypoabsorptive advantages of a gastric bypass. SADI-S has demonstrated excellent weight loss outcomes and technical feasibility. OBJECTIVES To evaluate the benefits of SADI-S in patients with obesity and type 2 diabetes mellitus. SETTING Academic and private practice hospitals, United States. METHODS Following the institutional review board (IRB) approval, a multicenter retrospective review was conducted to evaluate adult patients with obesity and type 2 diabetes who underwent SADI-S between January 1, 2013, and April 1, 2023. Type 2 diabetes remission was defined as a hemoglobin A1C (HbA1C) value of <6.5% in the absence of any antidiabetic medication use. Patient demographics and bariatric and metabolic-related parameters were collected. RESULTS A total of 419 consecutive patients were identified with a median age of 50.0 years (interquartile range [IQR] 17) and a mean body mass index (BMI) of 47.1 ± 8.9 kg/m2. The mean percentage of total weight loss (%TWL) was 31.9% with a type 2 diabetes remission rate of 60.1% and a mean follow-up period of 2.0 years. Two hundred twenty-six patients were included in the final analysis. Preoperative insulin use and higher BMI were negative predictors of type 2 diabetes remission, whereas greater %TWL was associated with a higher likelihood of type 2 diabetes remission at the last follow-up. On average, patients maintained reduced HbA1C values. CONCLUSIONS SADI-S is an effective and durable metabolic and bariatric surgery (MBS) for patients with obesity and type 2 diabetes. Patients with higher preoperative BMI and insulin use are less likely to experience type 2 diabetes remission after surgery.
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Affiliation(s)
- Jack W Sample
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel Cottam
- Bariatric Medicine Institute, Salt Lake City, Utah, USA
| | - Romulo Lind
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, Florida
| | - Amit Surve
- Bariatric Medicine Institute, Salt Lake City, Utah, USA
| | - Muhammad Ghanem
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, Florida
| | | | - Simon Laplante
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Calista Kee
- Bariatric Medicine Institute, Salt Lake City, Utah, USA
| | | | - Brian Mooers
- Bariatric Medicine Institute, Salt Lake City, Utah, USA
| | - Tatum Cottam
- Bariatric Medicine Institute, Salt Lake City, Utah, USA
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, Florida
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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17
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Birkenfeld AL, Bergman M. Bodyweight loss and remission of type 2 diabetes. Lancet Diabetes Endocrinol 2025; 13:265-267. [PMID: 40023187 DOI: 10.1016/s2213-8587(24)00373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 11/28/2024] [Indexed: 03/04/2025]
Affiliation(s)
- Andreas L Birkenfeld
- Department of Internal Medicine IV, Diabetology, Endocrinology and Nephrology, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, Eberhard Karls University Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Department of Diabetes, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK.
| | - Michael Bergman
- Departments of Medicine and Population Health, Holman Division of Endocrinology, Diabetes, Metabolism, NYU Grossman School of Medicine, VA New York Harbor Healthcare System, New York, NY, USA
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18
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Morissette A, Mulvihill EE. Cardioprotective benefits of metabolic surgery and GLP-1 receptor agonist-based therapies. Trends Endocrinol Metab 2025; 36:316-329. [PMID: 39127552 DOI: 10.1016/j.tem.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
Individuals with excessive adipose tissue and type 2 diabetes mellitus (T2DM) face a heightened risk of cardiovascular morbidity and mortality. Metabolic surgery is an effective therapy for people with severe obesity to achieve significant weight loss. Additionally, metabolic surgery improves blood glucose levels and can lead to T2DM remission, reducing major adverse cardiovascular outcomes (MACE). Glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1RAs) are a class of medication that effectively reduce body weight and MACE in patients with T2DM. This review explores the potential mechanisms underlying the cardioprotective benefits of metabolic surgery and GLP-1RA-based therapies and discusses recent evidence and emerging therapies in this dynamic area of research.
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Affiliation(s)
- Arianne Morissette
- The University of Ottawa Heart Institute, 40 Ruskin Street, H-3229A, Ottawa, Ontario, KIY 4W7, Canada
| | - Erin E Mulvihill
- The University of Ottawa Heart Institute, 40 Ruskin Street, H-3229A, Ottawa, Ontario, KIY 4W7, Canada; Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, The University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
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19
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Wu X, Huang Q, Ding Y, Cao Q, Jiang Y, Xu Y, Zhao Z, Xu M, Lu J, Wang T, Ning G, Wang W, Bi Y, Xu Y, Li M. Effect of insulin sensitivity, insulin secretion, and beta cell function on the remission of type 2 diabetes: A post hoc analysis of the IDEATE trial. Diabetes Obes Metab 2025; 27:1868-1877. [PMID: 39806566 DOI: 10.1111/dom.16180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 12/17/2024] [Accepted: 12/26/2024] [Indexed: 01/16/2025]
Abstract
AIMS To compare the probability of achieving diabetes remission in individuals with different phenotypes of insulin sensitivity, insulin secretion, and beta cell function and further detect the effects of diet, exercise, and lifestyle education intervention on these indexes. METHODS Three-hundred and one participants who had glycated haemoglobin (HbA1c) data at baseline and after intervention were included for this post hoc analysis. We used the multi-way analysis of variance to assess the differences between the diabetes remission and non-remission groups or between intervention groups in changes of the indexes of insulin sensitivity, insulin secretion, and beta cell function. Furthermore, logistic regression analysis was used to identify the association between the diabetes remission and baseline and change of each insulin index. RESULTS Participants with a higher disposition index (DI) or higher adaptation index at baseline were more likely to achieve diabetes remission. The diabetes remission group had a significantly greater increase in AUCc-pep0-30/AUCgluc0-30, DI, and adaptation index compared with the non-remission group, while there were no between-group differences in indexes of insulin sensitivity. Participants with greater increases in insulin secretion and beta cell function were more likely to achieve diabetes remission. Indexes of beta cell function improved in all intervention groups, while the diet intervention induced significant improvement compared with lifestyle education. CONCLUSIONS These findings supported the importance of aggressively implementing intensive lifestyle interventions for individuals with type 2 diabetes at an early stage of the disease, when beta cell function was not yet significantly impaired, to promote achieving diabetes remission.
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Affiliation(s)
- Xianglin Wu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiuyue Huang
- Lifecycle Health Management Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Digital Medicine Innovation Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Ding
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiuyu Cao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Youjin Jiang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuchen Xu
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Lifecycle Health Management Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Digital Medicine Innovation Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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20
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Tan SYT, Lee YQ, Syn G, Tseng FS, Chua JKL, Tan HC, Ho ETL, Kovalik JP, Lim CH, Eng AKH, Chan WH, Lim EKW, Tan JTH, Foo AX, Goh OQM, Lee PC. Greater durability of weight loss at ten years with gastric bypass compared to sleeve gastrectomy. Int J Obes (Lond) 2025:10.1038/s41366-025-01760-2. [PMID: 40148563 DOI: 10.1038/s41366-025-01760-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 03/05/2025] [Accepted: 03/20/2025] [Indexed: 03/29/2025]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) and gastric bypass (GB) are the most commonly performed bariatric surgeries. However, there is insufficient data on which leads to greater long-term (10 year) weight loss. METHODS Subjects who underwent SG and GB from 2008-2013 were followed up at 2, 5, and 10 years post-operatively for weight and diabetes (DM) outcomes. Percentage total weight loss (%TWL), weight regain ( ≥ 20% from nadir) and DM remission rates were compared. RESULTS Subjects (n = 253) who underwent SG (60.9%) and GB (39.1%) were included. The mean age was 41.4 ± 10.6 y, 39.1% were male, and the mean body mass index was 42.1 ± 9.3 kg/m2 with no significant difference between groups. The GB group had a greater proportion of subjects with DM (83.8% vs 19.5%, p < 0.001). At 2 y, %TWL was comparable (GB: 22.3 ± 9.6%, SG: 22.6 ± 10.5%, p = 0.824). However, those who underwent GB had significantly higher %TWL at 5 y (GB: 21.5 ± 8.9%, SG 18.0 ± 11.3%, p = 0.029) and 10 y (GB: 21.0 ± 9.0%, SG: 15.4 ± 12.1%, p = 0.001). The rate of significant weight regain was higher amongst the SG group at both 5 y (SG: 14.7%, GB: 3.8%, p = 0.018) and 10 y (SG: 27.9%, GB: 13.7%, p = 0.037) post-operatively. On multiple linear regression, GB remained significantly associated with greater %TWL at 10 y compared to SG (b = 5.51; adjusted p-value = 0.013), after adjusting for age, sex, pre-operative BMI, pre-operative glycemic status, and surgery year. There was no difference in DM remission rates at 10 y (SG: 26.7%, GB: 19.1%, p = 0.385). CONCLUSION GB was able to produce greater %TWL and less weight regain than SG at 5 and 10 years post-operatively. There was no difference in long-term DM remission rates between the two surgeries.
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Affiliation(s)
- Sarah Ying Tse Tan
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
| | - Yong Qin Lee
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Gwyneth Syn
- SingHealth Polyclinics, Singapore, Singapore
| | - Fan Shuen Tseng
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Emily Tse Lin Ho
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Jean Paul Kovalik
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Alvin Kim Hock Eng
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Weng Hoong Chan
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Eugene Kee Wee Lim
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | | | | | - Orlanda Qi Mei Goh
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
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21
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Boughanem H, Gutierrez-Mariscal FM, Arenas-de Larriva AP, Torres-Peña JD, Romero-Cabrera JL, Rangel-Zuñiga OA, García-Fernández H, Podadera-Herreros A, Rodríguez-Cantalejo F, Soehnlein O, Macias-Gonzalez M, Tinahones FJ, Yubero Serrano EM, Perez-Martinez P, Delgado-Lista J, López-Miranda J. Effect of long-term Mediterranean versus low-fat diet on neutrophil count, and type 2 diabetes mellitus remission in patients with coronary heart disease: results from the CORDIOPREV study. Nutr Diabetes 2025; 15:11. [PMID: 40148287 PMCID: PMC11950348 DOI: 10.1038/s41387-025-00360-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 12/19/2024] [Accepted: 01/24/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Recent evidence links diet and physical activity with type 2 diabetes mellitus (T2DM) remission, but emerging findings suggest that immune system dysregulation may play a crucial role. This study aimed to investigate the associations between neutrophils and T2DM remission. METHODS We conducted a comprehensive analysis of newly-diagnosed T2DM patients (N = 183) from the CORDIOPREV study, without glucose-lowering treatment, and were randomized to follow either a Mediterranean or low-fat diet. Patients were classified into two groups: Responders, who achieved T2DM remission (n = 73), and Non-Responders, who did not achieve remission during the 5-year dietary intervention (n = 110). Neutrophil count and their related-ratio (NER, NBR, NLR and NHR, normalized with erythrocytes, basophils, lymphocytes, and HDL respectively) were measured at the baseline and 5 years of follow-up. RESULTS The lowest baseline tertile of neutrophil count was associated with an increased likelihood of T2DM remission among patients following a Mediterranean diet (but not for low-fat diet) when compared with the highest tertile [adjusted HR of 4.23 (95% CI: 1.53-11.69)], in which similar results were observed for NER and NHR. When considering clinical and neutrophil variables, the predictive capacity of this model yielded an AUC of 0.783 (95% CI: 0.680-0.822). Furthermore, after 5-years, Responders exhibited lower neutrophil count compared to Non-responders (p = 0.006) and a significant decrease in neutrophil count (p = 0.001) compared to baseline. This decrease in neutrophil count in Responders who consumed a Mediterranean diet exhibited a significant increase in Insulin Sensitivity and Disposition Index (p = 0.011 and p = 0.018) after the follow-up period. CONCLUSION These findings suggest that neutrophil count can help in identifying patients that are more likely to achieve T2DM remission following a Mediterranean diet, suggesting a role on insulin sensitivity and β-cell function. Further research holds promise for providing valuable insights into the pathophysiology of T2DM. CLINICAL TRIAL REGISTRATION ID: NCT00924937; URL Clinical trial: https://clinicaltrials.gov/study/NCT00924937?cond=NCT00924937&rank=1 .
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Affiliation(s)
- Hatim Boughanem
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco M Gutierrez-Mariscal
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Pablo Arenas-de Larriva
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - José D Torres-Peña
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan L Romero-Cabrera
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Oriol Alberto Rangel-Zuñiga
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Helena García-Fernández
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Alicia Podadera-Herreros
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Oliver Soehnlein
- Institute of Experimental Pathology (ExPat), Center of Molecular Biology of Inflammation (ZMBE), University of Münster, Münster, Germany
| | - Manuel Macias-Gonzalez
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Malaga, Spain. Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, Malaga, Spain
| | - Francisco J Tinahones
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Malaga, Spain. Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, Malaga, Spain
| | - Elena M Yubero Serrano
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo Perez-Martinez
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - José López-Miranda
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Cordoba, Spain.
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Cordoba, Spain.
- Maimonides Institute for Biomedical Research in Cordoba (IMIBIC), Cordoba, Spain.
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
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22
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Diez-Valcarce I, Pisano-González MM, García CF, Linstrom J, Zaletel J, Giacomozzi C, Tolika F, Hidalgo IR, Lana A. Multidisciplinary lifestyle treatment for type 2 diabetes in 12 European countries: protocol for a quasi-experimental study. BMC Public Health 2025; 25:1069. [PMID: 40108551 PMCID: PMC11924863 DOI: 10.1186/s12889-025-22246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Accepted: 03/07/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND The incidence and prevalence of type 2 diabetes (T2DM) are expected to continue rising. T2DM causes life-threatening, disabling and costly complications, and significantly reduces quality of life and life expectancy. The burden of T2DM can be reduced using comprehensive lifestyle modifications. The aim of this study is to evaluate the applicability and cost-effectiveness of a multicomponent, multidisciplinary lifestyle program in 22 European regions and to generate guidelines for transfer to European health care systems. METHODS A quasi-experimental study (without a control group) will be conducted to evaluate the CARE4DIABETES program, which is based on the Reverse Diabetes 2Now best practice. The program will involve more than 120 healthcare professionals and 860 people with T2DM from 12 European countries - Belgium, Bulgaria, Finland, Hungary, Italy, Greece, Malta, Poland, Portugal, Slovakia, Slovenia and Spain. Patients will be enrolled based on clinical criteria and motivation for change. The program will have two phases, an intensive phase (6 months) with face-to-face and online training to achieve behavioral change, and an online aftercare phase (6 months) to consolidate changes. The program will be evaluated for impact, sustainability and cost-effectiveness using a combination of validated questionnaires at baseline, six months and one year after the start of the intervention. CLINICAL TRIAL NUMBER Trial registration number: ISRCTN62063346.
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Affiliation(s)
- Isabel Diez-Valcarce
- Regional Health Service of the Principality of Asturias (SESPA), Plaza del Carbayon 1,2, Oviedo, Asturias, 33017, España
| | - Marta M Pisano-González
- Ministry of Health of the Principality of Asturias (CSPA), Calle Ciriaco Miguel Vigil, 9, Oviedo, 33005, España.
- Health Research Institute of the Principality of Asturias (ISPA), Avda. del Hospital Universitario, Oviedo, s/n, 33011, España.
| | - Cristina Fernández García
- Regional Health Service of the Principality of Asturias (SESPA), Plaza del Carbayon 1,2, Oviedo, Asturias, 33017, España
- Health Research Institute of the Principality of Asturias (ISPA), Avda. del Hospital Universitario, Oviedo, s/n, 33011, España
| | - Jaana Linstrom
- Department of Public Health, National Institute for Health and Welfare, POB 30, Helsinki, 00271, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, POB 1627, Kuopio, 70211, Finland
| | - Jelka Zaletel
- National Institute of Public Health, Trubarjeva cesta 2, Ljubljana, 1000, Slovenia
| | - Claudia Giacomozzi
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, The Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Foetini Tolika
- Directorate of Public Health, 1st Regional Healthcare Authority of Attica, Ministry of Health, 18, Valaoritou Str., Athens, 10671, Greece
| | - Inés Rey Hidalgo
- Health Research Institute of the Principality of Asturias (ISPA), Avda. del Hospital Universitario, Oviedo, s/n, 33011, España
- Foundation for the Promotion of Applied Scientific Research and Technology in Asturias (FICYT), Calle Cabo Noval, 11-1C, Oviedo, 33007, España
| | - Alberto Lana
- Health Research Institute of the Principality of Asturias (ISPA), Avda. del Hospital Universitario, Oviedo, s/n, 33011, España
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Oviedo, Avda. Julián Clavería s/n, Oviedo, 33006, España
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23
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Schauer PR, Rothberg AE. Point-Counterpoint Debate: Surgery vs Medical Treatment for the Management of Obesity. J Clin Endocrinol Metab 2025; 110:e1282-e1287. [PMID: 39693237 DOI: 10.1210/clinem/dgae888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/16/2024] [Accepted: 12/17/2024] [Indexed: 12/20/2024]
Abstract
Obesity is a chronic, relapsing condition with severe health risks and a huge economic burden. Effective interventions for severe obesity include bariatric or metabolic surgery and high-intensity medical management involving lifestyle changes and pharmacotherapy. This article summarizes the debate between Drs. Schauer and Rothberg at the June 2024 Endocrine Society meeting regarding the optimal approach to managing obesity, exploring mechanisms, outcomes, safety, quality-of-life, and cost-effectiveness. Metabolic surgery results in substantial and sustained weight loss, improvements in comorbidities such as type 2 diabetes, and reduced mortality, and it is cost-effective. However, it carries risks associated with surgery and long-term complications, and its high upfront costs limit its scalability. Conversely, high-intensity medical management, which includes comprehensive lifestyle interventions and pharmacotherapy, leads to meaningful, though sometimes less substantial, weight loss and health improvements. The latter approach prioritizes behavioral changes and is cost-effective but requires patient adherence and faces challenges with medication side effects and costs. Both interventions offer substantial health benefits; the choice between them should consider individual patient needs, health status, target weight loss, and personal preferences. Metabolic surgery may be more suitable for individuals with severe obesity or when comorbidities are inadequately controlled, whereas medical management may be more suited to patients with less severe obesity and those preferring nonsurgical options. Future research should investigate the combined effects of surgery and medical management and enhance access to and affordability of these treatments. A multidisciplinary, personalized approach will likely yield the best outcomes in managing this complex health issue.
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Affiliation(s)
- Philip R Schauer
- Pennington Biomedical Research Institute of Louisiana State University in Baton Rouge, Baton Rouge, LA 70808, USA
| | - Amy E Rothberg
- Department of Internal Medicine, Michigan Medicine and Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48105, USA
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24
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Teicholz N, Croft SM, Cuaranta I, Cucuzzella M, Glandt M, Griauzde DH, Jerome-Zapadka K, Kalayjian T, Murphy K, Nelson M, Shanahan C, Nishida JL, Oh RC, Parrella N, Saner EM, Sethi S, Volek JS, Williden M, Wolver S. Myths and Facts Regarding Low-Carbohydrate Diets. Nutrients 2025; 17:1047. [PMID: 40292478 PMCID: PMC11944661 DOI: 10.3390/nu17061047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 02/15/2025] [Accepted: 03/06/2025] [Indexed: 04/30/2025] Open
Abstract
As the prevalence of chronic diseases persists at epidemic proportions, health practitioners face ongoing challenges in providing effective lifestyle treatments for their patients. Even for those patients on GLP-1 agonists, nutrition counseling remains a crucial strategy for managing these conditions over the long term. This paper aims to address the concerns of patients and practitioners who are interested in a low-carbohydrate or ketogenic diet, but who have concerns about its efficacy, safety, and long-term viability. The authors of this paper are practitioners who have used this approach and researchers engaged in its study. The paper reflects our opinion and is not meant to review low-carbohydrate diets systematically. In addressing common concerns, we hope to show that this approach has been well researched and can no longer be seen as a "fad diet" with adverse health effects such as impaired renal function or increased risk of heart disease. We also address persistent questions about patient adherence, affordability, and environmental sustainability. This paper reflects our perspective as clinicians and researchers engaged in the study and application of low-carbohydrate dietary interventions. While the paper is not a systematic review, all factual claims are substantiated with citations from the peer-reviewed literature and the most rigorous and recent science. To our knowledge, this paper is the first to address potential misconceptions about low-carbohydrate and ketogenic diets comprehensively.
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Affiliation(s)
| | | | | | - Mark Cucuzzella
- Department of Family Medicine, West Virginia University School of Medicine, Morgantown, WV 26506, USA
- Martinsburg Veterans Administration Hospital, Martinsburg, WV 25405, USA
| | | | - Dina H. Griauzde
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Karen Jerome-Zapadka
- Valley Gastroenterology Associates, Beaver Falls, PA 15010, USA
- Trajectory Health Partners, Mars, PA 16046, USA
| | - Tro Kalayjian
- Greenwich Hospital, Yale New Haven Health, Greenwich, CT 06830, USA
| | - Kendrick Murphy
- Western North Carolina VA Health Care System, Asheville, NC 28805, USA
| | - Mark Nelson
- Independent Researcher, Chicago, IL 60174, USA
| | | | | | - Robert C. Oh
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Naomi Parrella
- Department of Family and Preventive Medicine, Rush Medical College, Chicago, IL 60612, USA
- Department of Surgery, Rush Medical College, Chicago, IL 60612, USA
| | - Erin M. Saner
- Department of Family & Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Shebani Sethi
- Metabolic Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jeff S. Volek
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | | | - Susan Wolver
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
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25
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Liu Z, Feng N, Wang S, Liu Y, Wang J, Tan Y, Dong Y, Sun Z, Du X, Xu Y, Tao F, Zhong VW. Low-calorie diets and remission of type 2 diabetes in Chinese: phenotypic changes and individual variability. Nutr J 2025; 24:42. [PMID: 40087696 PMCID: PMC11908006 DOI: 10.1186/s12937-025-01101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 02/21/2025] [Indexed: 03/17/2025] Open
Abstract
BACKGROUND Chinese have distinct phenotypes of type 2 diabetes (T2D) and obesity compared with people of other ethnicities, but using low-calorie diets to achieve T2D remission has never been conducted in Chinese. This study aimed to assess if T2D remission can be achieved using low-calorie formula diet (LCFD) and low-calorie real food-based diet (LCRFD) in Chinese similarly to other populations and to identify determinants of individual variability in T2D remission. METHODS This 6-month intervention consisted of a 3-month isocaloric intensive weight loss phase (815-835 kcal/d) and a 3-month weight maintenance phase. Enrolled participants with T2D had BMI of 24-45 kg/m2 and HbA1c level of 6.5-12.0% (< 6.5% if on medication). Everyone stopped anti-diabetic drugs on day 1 and was assigned to receive LCFD (n = 21) or LCRFD (n = 20). RESULTS At 6 months, 29.3% of participants had ≥ 12 kg weight loss, 39.0% lost ≥ 10% weight, and 56.1% achieved T2D remission. MRI-derived liver and pancreatic fat decreased significantly. Significant improvement was also seen in insulin sensitivity, continuous glucose monitoring-derived metrics, and various other cardiometabolic risk factors but not arginine-induced insulin secretory response. There was no difference in all outcomes between LCFD and LCRFD. Compared with responders for T2D remission, nonresponders were more likely to be women, and had more fat mass, longer diabetes duration, poorer glycemic control, and lower beta-cell function. CONCLUSIONS T2D remission rate and weight loss amount following low-calorie diet intervention in Chinese people were comparable to those reported from other populations, although individual variability existed. LCFD and LCRFD were similarly effective. TRIAL REGISTRATION The trial was registered with ClinicalTrials.gov: NCT05472272.
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Affiliation(s)
- Zhenxiu Liu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200025, China
| | - Nannan Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, 415 East No. 1 Building 227 South Chongqing Rd, Shanghai, China
| | - Sujing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, 415 East No. 1 Building 227 South Chongqing Rd, Shanghai, China
| | - Yang Liu
- Department of Clinical Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Wang
- Department of Chinese Medicine & Integrative Medicine, Shanghai Geriatric Medical Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yue Tan
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200025, China
| | - Ying Dong
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, 415 East No. 1 Building 227 South Chongqing Rd, Shanghai, China
| | - Zhewei Sun
- Department of Health and Behavioral Studies, Teachers College, Columbia University, New York, USA
| | - Xihao Du
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, 415 East No. 1 Building 227 South Chongqing Rd, Shanghai, China
| | - Yaqing Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, 415 East No. 1 Building 227 South Chongqing Rd, Shanghai, China
| | - Feng Tao
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200025, China
| | - Victor W Zhong
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, 415 East No. 1 Building 227 South Chongqing Rd, Shanghai, China.
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Gamlestøl RS, Andersen JR, Våge V. Long-term glycemic control after sleeve gastrectomy and biliopancreatic diversion with duodenal switch in patients with type 2 diabetes mellitus. Scand J Surg 2025:14574969251321965. [PMID: 40035339 DOI: 10.1177/14574969251321965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2025]
Abstract
BACKGROUND AND OBJECTIVES Long-term studies exploring factors associated with glycemic control of type 2 diabetes mellitus (T2DM) after bariatric surgery are being requested. This prospective cohort study aimed to evaluate potential predictors of long-term glycemic control 5 years after surgery. METHODS Patients were operated between 2002 and 2014. Data were collected prospectively in a database after obtaining written informed consent from the patients. Surgical methods were sleeve gastrectomy (SG) or biliopancreatic diversion with duodenal switch (BPDDS). Possible predictors of postoperative long-term glycemic control (HbA1c) were investigated using multiple path regression analysis, which handles missing data. RESULTS A total of 181 patients were included consecutively, 87 after SG and 94 after BPDDS. The follow-up rate was 124/181 (69%), 57 (66%) after SG and 67 (71%) after BPDDS. We found that 39/57 (68%) of the patients who underwent SG and 54/67 (81%) of the patients who underwent BPDDS had remission of T2DM at 5 years. Lower preoperative HbA1c (P < 0.010), higher preoperative C-peptide (P = 0.004), greater percent total weight loss (P < 0.005), and the BPDDS procedure (P < 0.001) were associated with better postoperative long-term glycemic control (explained variance = 39.4%). CONCLUSIONS Both procedures, especially BPDDS, were effective in achieving long-term glycemic control. Lower preoperative HbA1c, higher C-peptide levels, greater weight loss, and the BPDDS procedure were key predictors of better long-term glycemic control.
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Affiliation(s)
- Randi S Gamlestøl
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - John R Andersen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Health Research Sogn og Fjordane, Førde Hospital Trust, Førde, Norway
| | - Villy Våge
- Health Research Sogn og Fjordane Førde Hospital Trust Svanehaugvegen 2 Førde 6812 Norway
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Kim MK, Kim J, Park SJ, Song YJ, Kwon HS. Impact of caloric restriction on diabetes remission in Korean adults with obesity (CREDO-K study). Diabetes Obes Metab 2025; 27:1609-1613. [PMID: 39749728 DOI: 10.1111/dom.16166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 12/11/2024] [Accepted: 12/18/2024] [Indexed: 01/04/2025]
Affiliation(s)
- Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jinyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su-Jeong Park
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
| | - Yoon-Ju Song
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Rubino F, Cummings DE, Eckel RH, Cohen RV, Wilding JPH, Brown WA, Stanford FC, Batterham RL, Farooqi IS, Farpour-Lambert NJ, le Roux CW, Sattar N, Baur LA, Morrison KM, Misra A, Kadowaki T, Tham KW, Sumithran P, Garvey WT, Kirwan JP, Fernández-Real JM, Corkey BE, Toplak H, Kokkinos A, Kushner RF, Branca F, Valabhji J, Blüher M, Bornstein SR, Grill HJ, Ravussin E, Gregg E, Al Busaidi NB, Alfaris NF, Al Ozairi E, Carlsson LMS, Clément K, Després JP, Dixon JB, Galea G, Kaplan LM, Laferrère B, Laville M, Lim S, Luna Fuentes JR, Mooney VM, Nadglowski J, Urudinachi A, Olszanecka-Glinianowicz M, Pan A, Pattou F, Schauer PR, Tschöp MH, van der Merwe MT, Vettor R, Mingrone G. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol 2025; 13:221-262. [PMID: 39824205 PMCID: PMC11870235 DOI: 10.1016/s2213-8587(24)00316-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 09/15/2024] [Accepted: 10/07/2024] [Indexed: 01/20/2025]
Abstract
Current BMI-based measures of obesity can both underestimate and overestimate adiposity and provide inadequate information about health at the individual level, which undermines medically-sound approaches to health care and policy. This Commission sought to define clinical obesity as a condition of illness that, akin to the notion of chronic disease in other medical specialties, directly results from the effect of excess adiposity on the function of organs and tissues. The specific aim of the Commission was to establish objective criteria for disease diagnosis, aiding clinical decision making and prioritisation of therapeutic interventions and public health strategies. To this end, a group of 58 experts—representing multiple medical specialties and countries—discussed available evidence and participated in a consensus development process. Among these commissioners were people with lived experience of obesity to ensure consideration of patients’ perspectives. The Commission defines obesity as a condition characterised by excess adiposity, with or without abnormal distribution or function of adipose tissue, and with causes that are multifactorial and still incompletely understood. We define clinical obesity as a chronic, systemic illness characterised by alterations in the function of tissues, organs, the entire individual, or a combination thereof, due to excess adiposity. Clinical obesity can lead to severe end-organ damage, causing life-altering and potentially life-threatening complications (eg, heart attack, stroke, and renal failure). We define preclinical obesity as a state of excess adiposity with preserved function of other tissues and organs and a varying, but generally increased, risk of developing clinical obesity and several other non-communicable diseases (eg, type 2 diabetes, cardiovascular disease, certain types of cancer, and mental disorders). Although the risk of mortality and obesity-associated diseases can rise as a continuum across increasing levels of fat mass, we differentiate between preclinical and clinical obesity (ie, health vs illness) for clinical and policy-related purposes. We recommend that BMI should be used only as a surrogate measure of health risk at a population level, for epidemiological studies, or for screening purposes, rather than as an individual measure of health. Excess adiposity should be confirmed by either direct measurement of body fat, where available, or at least one anthropometric criterion (eg, waist circumference, waist-to-hip ratio, or waist-to-height ratio) in addition to BMI, using validated methods and cutoff points appropriate to age, gender, and ethnicity. In people with very high BMI (ie, >40 kg/m2), however, excess adiposity can pragmatically be assumed, and no further confirmation is required. We also recommend that people with confirmed obesity status (ie, excess adiposity with or without abnormal organ or tissue function) should be assessed for clinical obesity. The diagnosis of clinical obesity requires one or both of the following main criteria: evidence of reduced organ or tissue function due to obesity (ie, signs, symptoms, or diagnostic tests showing abnormalities in the function of one or more tissue or organ system); or substantial, age-adjusted limitations of daily activities reflecting the specific effect of obesity on mobility, other basic activities of daily living (eg, bathing, dressing, toileting, continence, and eating), or both. People with clinical obesity should receive timely, evidence-based treatment, with the aim to induce improvement (or remission, when possible) of clinical manifestations of obesity and prevent progression to end-organ damage. People with preclinical obesity should undergo evidence-based health counselling, monitoring of their health status over time, and, when applicable, appropriate intervention to reduce risk of developing clinical obesity and other obesity-related diseases, as appropriate for the level of individual health risk. Policy makers and health authorities should ensure adequate and equitable access to available evidence-based treatments for individuals with clinical obesity, as appropriate for people with a chronic and potentially life-threatening illness. Public health strategies to reduce the incidence and prevalence of obesity at population levels must be based on current scientific evidence, rather than unproven assumptions that blame individual responsibility for the development of obesity. Weight-based bias and stigma are major obstacles in efforts to effectively prevent and treat obesity; health-care professionals and policy makers should receive proper training to address this important issue of obesity. All recommendations presented in this Commission have been agreed with the highest level of consensus among the commissioners (grade of agreement 90–100%) and have been endorsed by 76 organisations worldwide, including scientific societies and patient advocacy groups.
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Affiliation(s)
- Francesco Rubino
- Metabolic and Bariatric Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK; King's College Hospital, London, UK.
| | - David E Cummings
- University of Washington, Seattle, WA, USA; Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - John P H Wilding
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - Wendy A Brown
- Monash University Department of Surgery, Central Clinical School, Alfred Health, Melbourne, VIC, Australia
| | - Fatima Cody Stanford
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rachel L Batterham
- International Medical Affairs, Eli Lilly, Basingstoke, UK; Diabetes and Endocrinology, University College London, London, UK
| | - I Sadaf Farooqi
- Institute of Metabolic Science and National Institute for Health and Care Research, Cambridge Biomedical Research Centre at Addenbrookes Hospital, Cambridge, UK
| | - Nathalie J Farpour-Lambert
- Obesity Prevention and Care Program, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Louise A Baur
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Weight Management Services, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Katherine M Morrison
- Centre for Metabolism, Obesity and Diabetes Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada; McMaster Children's Hospital, Hamilton, ON, Canada
| | - Anoop Misra
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India; National Diabetes Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation New Delhi, India
| | | | - Kwang Wei Tham
- Department of Endocrinology, Woodlands Health, National Healthcare Group, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Priya Sumithran
- Department of Surgery, School of Translational Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia
| | - W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John P Kirwan
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - José-Manuel Fernández-Real
- CIBER Pathophysiology of Obesity and Nutrition, Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain; Hospital Trueta of Girona and Institut d'Investigació Biomèdica de Girona, Girona, Spain
| | - Barbara E Corkey
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Hermann Toplak
- Division of Endocrinology and Diabetology, Department of Medicine, University of Graz, Graz, Austria
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Robert F Kushner
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Francesco Branca
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Jonathan Valabhji
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK; Department of Diabetes and Endocrinology, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, UK
| | - Matthias Blüher
- Helmholtz Institute for Metabolic, Obesity and Vascular Research of Helmholtz Munich, University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Stefan R Bornstein
- Department of Internal Medicine III, Carl Gustav Carus University Hospital Dresden, Technical University Dresden, Dresden, Germany; School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Harvey J Grill
- Institute of Diabetes, Obesity and Metabolism, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Edward Gregg
- School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; School of Public Health, Imperial College London, London, UK
| | - Noor B Al Busaidi
- National Diabetes and Endocrine Center, Royal Hospital, Muscat, Oman; Oman Diabetes Association, Muscat, Oman
| | - Nasreen F Alfaris
- Obesity Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ebaa Al Ozairi
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait
| | - Lena M S Carlsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karine Clément
- Nutrition and Obesities: Systemic Approaches, NutriOmics Research Group, INSERM, Sorbonne Université, Paris, France; Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hospital of Paris, Paris, France
| | | | - John B Dixon
- Iverson Health Innovation Research institute, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Gauden Galea
- Regional Office for Europe, World Health Organization, Geneva, Switzerland
| | - Lee M Kaplan
- Section on Obesity Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Blandine Laferrère
- Division of Endocrinology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, South Korea
| | | | - Vicki M Mooney
- European Coalition for people Living with Obesity, Dublin, Ireland
| | | | - Agbo Urudinachi
- Department of Community Health, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Magdalena Olszanecka-Glinianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Science, Medical University of Silesia, Katowice, Poland
| | - An Pan
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Francois Pattou
- Translational Research for Diabetes, Lille University, Lille University Hospital, Inserm, Institut Pasteur Lille, Lille, France; Department of General and Endocrine Surgery, Lille University Hospital, Lille, France
| | | | - Matthias H Tschöp
- Helmholtz Munich, Munich, Germany; Technical University of Munich, Munich, Germany
| | - Maria T van der Merwe
- University of Pretoria, Pretoria, South Africa; Nectare Waterfall City Hospital, Midrand, South Africa
| | - Roberto Vettor
- Internal Medicine, Center for the Study and the Integrated Treatment of Obesity, Department of Medicine, University of Padova, Padua, Italy; Center for Metabolic and Nutrition Related Diseases,Humanitas Research Hospital, Milan, Italy
| | - Geltrude Mingrone
- Division of Diabetes & Nutritional Sciences, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK; Catholic University of the Sacred Heart, Rome, Italy; University Polyclinic Foundation Agostino Gemelli IRCCS, Rome, Italy
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Yao S, Shen Y, Xiong J, Wei L, Zhao J, Wang Z, Zhu G. Modeling diabetes progression with risk factors: A case study in China. Comput Biol Med 2025; 186:109643. [PMID: 39740511 DOI: 10.1016/j.compbiomed.2024.109643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 12/26/2024] [Accepted: 12/27/2024] [Indexed: 01/02/2025]
Abstract
BACKGROUND Approximately 537 million adults worldwide have diabetes, more than 90 % of which is type 2 diabetes mellitus (T2DM). China has the largest number of people living with diabetes. Understanding the epidemiological mechanism can guide diabetes surveillance and control. METHODS Utilizing the most recent Global Burden of Disease 2021 (GBD2021) data on T2DM and risk factor exposure values, we developed a modelling framework that employs systems of difference equations to project the future burden of diabetes among the Chinese population. The model characterized the diabetes progression process from no diabetes, undiagnosed diabetes, and diagnosed diabetes with and without complications, in which genetic and lifestyle factors modulate the rate of development at these stages. We focused on the long-term dynamics of diabetes progression with the impacts of influence factors. We then fit the model to the longitudinal numbers of T2DM patients by Markov chain Monte Carlo (MCMC) algorithm. RESULTS The model with the influencing factors fitted an R2 of 98 % for the T2DM cases in China during the period 1990-2021. The incidence rate would keep increasing from 299.93/100,000 in 2022 to 421.58/100,000 in 2050 and 500.16/100,000 in 2080. The prevalence rates in 2040, 2060, and 2080 could be 14.62 %, 23.57 % and 34.83 %, respectively. The number of new cases was the most sensitive to high body mass index (BMI), followed by smoking and low physical activity. A 50 % reduction in single risk factor exposure would reduce new cases in 2022-2080 by 4.24 %, 2.52 %, and 1.12 %, respectively. CONCLUSIONS This study provided a modelling framework to explore the mechanism of T2DM development, which allows to quantify the impacts of risk factors on T2DM progression. The results highlight the high burden of T2DM in China and emphasized the importance of lifestyle interventions.
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Affiliation(s)
- Shilu Yao
- School of Mathematics and Computing Science, Guilin University of Electronic Technology, Guilin, 541004, China
| | - Yangling Shen
- School of Mathematics and Computing Science, Guilin University of Electronic Technology, Guilin, 541004, China
| | - Jianling Xiong
- School of Mathematics and Computing Science, Guilin University of Electronic Technology, Guilin, 541004, China
| | - Liuxia Wei
- Guilin Maternal and Child Health Hospital, Guilin, 541001, China
| | - Jiangyan Zhao
- Guilin Maternal and Child Health Hospital, Guilin, 541001, China
| | - Zhen Wang
- School of Mathematics and Computing Science, Guilin University of Electronic Technology, Guilin, 541004, China; Center for Applied Mathematics of Guangxi (GUET), Guilin, 541004, China; Guangxi Colleges and Universities Key Laboratory of Data Analysis and Computation, Guilin, 541004, China
| | - Guanghu Zhu
- School of Mathematics and Computing Science, Guilin University of Electronic Technology, Guilin, 541004, China; Center for Applied Mathematics of Guangxi (GUET), Guilin, 541004, China; Guangxi Colleges and Universities Key Laboratory of Data Analysis and Computation, Guilin, 541004, China.
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Sandforth L, Kullmann S, Sandforth A, Fritsche A, Jumpertz-von Schwartzenberg R, Stefan N, Birkenfeld AL. Prediabetes remission to reduce the global burden of type 2 diabetes. Trends Endocrinol Metab 2025:S1043-2760(25)00004-9. [PMID: 39955249 DOI: 10.1016/j.tem.2025.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 12/12/2024] [Accepted: 01/15/2025] [Indexed: 02/17/2025]
Abstract
Prediabetes is a highly prevalent and increasingly common condition affecting a significant proportion of the global population. The heterogeneous nature of prediabetes presents a challenge in identifying individuals who particularly benefit from lifestyle or other therapeutic interventions aiming at preventing type 2 diabetes (T2D) and associated comorbidities. The phenotypic characteristics of individuals at risk for diabetes are associated with both specific risk profiles for progression and a differential potential to facilitate prediabetes remission and reduce the risk of future T2D. This review examines the current definition and global prevalence of prediabetes and evaluates the potential of prediabetes remission to reduce the alarming increase in the global burden of T2D.
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Affiliation(s)
- Leontine Sandforth
- Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, Tübingen, Germany; Internal Medicine IV, Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany; German Center for Diabetes Research, Tübingen, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, Tübingen, Germany; Internal Medicine IV, Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany; German Center for Diabetes Research, Tübingen, Germany
| | - Arvid Sandforth
- Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, Tübingen, Germany; Internal Medicine IV, Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany; German Center for Diabetes Research, Tübingen, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, Tübingen, Germany; Internal Medicine IV, Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany; German Center for Diabetes Research, Tübingen, Germany
| | - Reiner Jumpertz-von Schwartzenberg
- Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, Tübingen, Germany; Internal Medicine IV, Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany; German Center for Diabetes Research, Tübingen, Germany; M3 Research Center, Malignom, Metabolome, Microbiome, 72076 Tübingen, Germany; Cluster of Excellence EXC 2124 'Controlling Microbes to Fight Infections' (CMFI), University of Tübingen, Tübingen, Germany
| | - Norbert Stefan
- Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, Tübingen, Germany; Internal Medicine IV, Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany; German Center for Diabetes Research, Tübingen, Germany
| | - Andreas L Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, Tübingen, Germany; Internal Medicine IV, Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany; German Center for Diabetes Research, Tübingen, Germany; Department of Diabetes, Life Sciences, and Medicine, Cardiovascular Medicine and Life Sciences, King's College London, London, UK.
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Allum M, Buckley A, Suliman SGI, Suliman M, Hamdan K, Al Hadad M. Outcomes Following Metabolic Bariatric Surgery at a Single Center in the United Arab Emirates. Diabetes Metab Syndr Obes 2025; 18:249-260. [PMID: 39901918 PMCID: PMC11789772 DOI: 10.2147/dmso.s499361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Accepted: 01/10/2025] [Indexed: 02/05/2025] Open
Abstract
Introduction While the benefits of metabolic bariatric surgery (MBS) are well described, only few studies have been published from the Gulf region, where the impact of regional patient characteristics on outcomes remains poorly understood. Methods Data were reviewed for patients attending metabolic follow-up three or more months after primary MBS at our center in the UAE from 2016 to 2022. Total weight loss (TWL), status of type 2 diabetes (T2D), hyperlipidemia, and hypertension were assessed following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Results Of 2851 included patients, 62.6% were female and 94.0% Emirati. Pre-operatively, mean age was 34.2 ±0.2 years, median BMI was 41.0 (IQR 37.8-45.2) kg/m2; 92.5% had SG and 7.5% RYGB. %TWL (95% confidence interval) for RYGB was 31.2% (30.0-32.5), 30.9% (29.0-32.9) and 28.4% (23.0-33.8) at 1, 3 and 5 years. Following SG, %TWL was 29.9% (29.5-30.3), 25.8% (25.0-26.7) and 23.4% (21.6-25.2) for the same intervals. The proportion of total operated patients included was 60.2%, 43.7% and 33.8% respectively. Men lost more weight than women 12 months after SG, with mean %TWL of 32.5% (31.8-33.2) vs 28.4% (27.9-28.9) respectively. T2D remission (HbA1c <6.5% without diabetes medications) after SG was 61.9% (179/289) at 1 year and 40.9% (18/44) at 5 years. RYGB favored T2D remission over SG at 12 months, OR=2.272 (1.152-4.65). There was no difference between procedures for hypertension status, although remission from hyperlipidemia was higher 1 year after RYGB at 41.8% (23/55) compared to SG 16.4% (78/475) (p<0.001). Conclusion In this young Emirati cohort, RYGB was associated with more weight loss and favored T2D and hyperlipidemia remission over SG. Women lost less weight than men after SG. Weight recurrence from 1 to 5 years after SG was greater than the international average. Further research is required to explain these differences and improve outcomes.
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Affiliation(s)
- Matthew Allum
- Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Adam Buckley
- Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Sara G I Suliman
- Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Mohamed Suliman
- Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Khaled Hamdan
- Department of Bariatric and Metabolic Surgery, Healthpoint Hospital, Abu Dhabi, United Arab Emirates
| | - Mohamed Al Hadad
- Department of Bariatric and Metabolic Surgery, Healthpoint Hospital, Abu Dhabi, United Arab Emirates
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Shimayama C, Fujihara K, Khin L, Takizawa H, Horikawa C, Sato T, Kitazawa M, Matsubayashi Y, Yamada T, Sone H. Impact of diabetes remission or progression on the incidence of cardiovascular disease in Japan: historical cohort study using a nationwide claims database. Cardiovasc Diabetol 2025; 24:37. [PMID: 39844263 PMCID: PMC11756120 DOI: 10.1186/s12933-025-02578-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 01/03/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Previous studies demonstrated that diabetes remission can occur during intensive intervention and in real-world settings. However, the impact of diabetes remission in real-world settings on the incidence of cardiovascular disease (CVD) remains unclear. METHODS This retrospective cohort study included 299,967 individuals aged 20-72 years who underwent multiple checkups between 2008 and 2020 and completed ≥ 3 years of follow-up. Patients were divided into four groups according to changes in glycated hemoglobin levels and the use of diabetes medications during the 1-year baseline period: diabetes mellitus (DM)+/no remission, DM+/remission, DM-/no progression, and DM-/progression. The risk of CVD was evaluated using multivariable Cox regression analysis. RESULTS The median follow-up period was 5.0 years. The rates of CVD in the DM+/no remission, DM+/remission, DM-/no progression, and DM-/progression groups were 7.96, 4.76, 1.99, and 5.47 per 1000 person-years, respectively. Compared with DM+/no remission, DM+/remission reduced the risk of CVD [hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.57-0.89]. Meanwhile, the HR for CVD in the DM+/remission group was 0.75 (95% CI = 0.56-0.99) for change in BMI ≤ 0%, versus 0.66 (95% CI = 0.45-0.96) for change in BMI > 0%. CONCLUSIONS In a real-world setting without intensive intervention, diabetes remission decreased the risk of CVD by approximately 30% regardless of changes in BMI, suggesting that diabetes remission can prevent CVD without weight loss in routine care and emphasizing the importance of achieving remission.
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Affiliation(s)
- Chihiro Shimayama
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan
- Kowa Company, Ltd., Tokyo, Japan
| | - Kazuya Fujihara
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan.
| | - Laymon Khin
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan
| | - Hiroki Takizawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan
| | - Chika Horikawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan
- Department of Health and Nutrition, University of Niigata Prefecture Faculty of Human Life Studies, Niigata, Japan
| | - Takaaki Sato
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan
| | - Masaru Kitazawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan
| | - Yasuhiro Matsubayashi
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan
| | - Takaho Yamada
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan
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Gorgojo-Martínez JJ. Adipocentric Strategy for the Treatment of Type 2 Diabetes Mellitus. J Clin Med 2025; 14:678. [PMID: 39941348 PMCID: PMC11818433 DOI: 10.3390/jcm14030678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 01/16/2025] [Accepted: 01/18/2025] [Indexed: 02/16/2025] Open
Abstract
The global prevalence of obesity and type 2 diabetes mellitus (T2D) has risen in parallel over recent decades. Most individuals diagnosed with T2D exhibit adiposopathy-related diabetes (ARD), a condition characterized by hyperglycemia accompanied by three core features: increased ectopic and visceral fat deposition, dysregulated adipokine secretion favoring a pro-inflammatory state, and insulin resistance. Despite advancements in precision medicine, international guidelines for T2D continue to prioritize individualized therapeutic approaches focused on glycemic control and complications, and many healthcare providers predominantly maintain a glucocentric strategy. This review advocates for an adipocentric treatment paradigm for most individuals with T2D, emphasizing the importance of prioritizing weight loss and visceral fat reduction as key drivers of therapeutic intensification. By combining lifestyle modifications with pharmacological agents that promote weight loss-including SGLT-2 inhibitors, GLP-1 receptor agonists, or dual GLP-1/GIP receptor agonists-and, when appropriate, metabolic surgery, this approach offers the potential for disease remission in patients with shorter disease duration. For others, it enables superior metabolic control compared to traditional glucose-centered strategies while simultaneously delivering cardiovascular and renal benefits. In conclusion, an adipocentric treatment framework for ARD, which represents the majority of T2D cases, effectively integrates glucocentric and cardio-nephrocentric goals. This approach constitutes the optimal strategy for ARD due to its efficacy in achieving disease remission, improving metabolic control, addressing obesity-related comorbidities, and reducing cardiovascular and renal morbidity and mortality.
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Affiliation(s)
- Juan J Gorgojo-Martínez
- Department of Endocrinology and Nutrition, Hospital Universitario Fundación Alcorcón, C/Budapest 1, 28922 Alcorcón, Spain
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Yang S, Weiskirchen R, Zheng W, Hu X, Zou A, Liu Z, Wang H. A data-driven machine learning algorithm to predict the effectiveness of inulin intervention against type II diabetes. Front Nutr 2025; 11:1520779. [PMID: 39839293 PMCID: PMC11747270 DOI: 10.3389/fnut.2024.1520779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 12/18/2024] [Indexed: 01/23/2025] Open
Abstract
Introduction The incidence of type 2 diabetes mellitus (T2DM) has increased in recent years. Alongside traditional pharmacological treatments, nutritional therapy has emerged as a crucial aspect of T2DM management. Inulin, a fructan-type soluble fiber that promotes the growth of probiotic species like Bifidobacterium and Lactobacillus, is commonly used in nutritional interventions for T2DM. However, it remains unclear which type of T2DM patients are suitable for inulin intervention. The aim of this study was to predict the effectiveness of inulin treatment for T2DM using a machine learning model. Methods Original data were obtained from a previous study. After screening T2DM patients, feature election was conducted using LASSO regression, and a machine learning model was developed using XGBoost. The model's performance was evaluated based on accuracy, specificity, positive predictive value, negative predictive value and further analyzed using receiver operating curves, calibration curves, and decision curves. Results Out of the 758 T2DM patients included, 477 had their glycated hemoglobin (HbA1c) levels reduced to less than 6.5% after inulin intervention, resulting in an incidence rate of 62.93%. LASSO regression identified six key factors in patients prior to inulin treatment. The SHAP values for interpretation ranked the characteristic variables in descending order of importance: HbA1c, difference between fasting and 2 h-postprandial glucose levels, fasting blood glucose, high-density lipoprotein, age, and body mass index. The XGBoost prediction model demonstrated a training set accuracy of 0.819, specificity of 0.913, positive predictive value of 0.818, and negative predictive value of 0.820. The testing set showed an accuracy of 0.709, specificity of 0.909, positive predictive value of 0.705, and negative predictive value of 0.710. Conclusion The XGBoost-SHAP framework for predicting the impact of inulin intervention in T2DM treatment proves to be effective. It allows for the comparison of prediction effect based on different features of an individual, assessment of prediction abilities for different individuals given their features, and establishes a connection between machine learning and nutritional intervention in T2DM treatment. This offers valuable insights for researchers in this field.
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Affiliation(s)
- Shuheng Yang
- School of Life Science and Technology, Wuhan Polytechnic University, Wuhan, China
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH University Hospital, Aachen, Germany
| | - Wenjing Zheng
- School of Life Science and Technology, Wuhan Polytechnic University, Wuhan, China
| | - Xiangxu Hu
- School of Life Science and Technology, Wuhan Polytechnic University, Wuhan, China
| | - Aibiao Zou
- Research Center of Medical Nutrition Therapy, Cross-strait Tsinghua Research Institute, Xiamen, China
| | - Zhiguo Liu
- School of Life Science and Technology, Wuhan Polytechnic University, Wuhan, China
| | - Hualin Wang
- School of Life Science and Technology, Wuhan Polytechnic University, Wuhan, China
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Altulaihi B, Sawlan AM, Alwahbi NA, Alshahrani B, Alrayani YH, Alrayani YH. Long-Term Remission Rate of Type 2 Diabetes Following Bariatric Surgery: A Retrospective Cohort Study in Adult Patients in Riyadh, Saudi Arabia. Cureus 2025; 17:e76819. [PMID: 39758866 PMCID: PMC11696794 DOI: 10.7759/cureus.76819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2025] [Indexed: 01/07/2025] Open
Abstract
Introduction Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder that poses significant health and economic burdens, particularly in regions like Saudi Arabia where prevalence rates are among the highest globally. Bariatric surgery has emerged as a promising intervention, not only for weight reduction but also for inducing diabetes remission. However, while the short-term benefits of the procedure are well documented, long-term outcomes remain under-explored, especially in Saudi populations. This study aims to evaluate the long-term remission rates of T2DM and weight measurements following bariatric surgery in adult Saudi patients in Riyadh. Methods Using a retrospective cohort design, this study analyzes medical records of patients aged 18-65 who underwent bariatric surgery in the period of 2016-2020 and assesses Hemoglobin A1c (HbA1c) levels pre and post-surgery and diabetes remission using American Diabetes Association (ADA) criteria. The research also investigates factors influencing relapse rates and potential gender differences in remission outcomes. Results Out of 74 participants, the majority were females (53, 71.62%) compared to males (21, 28.37%). The mean BMI was recorded at 44.91 ± 6.68 kg/m2, indicating that participants generally fell within the obesity weight range. The mean HbA1c level prior to surgery was 8.70 ± 1.68, indicating suboptimal glycemic control at baseline. The mean HbA1c level decreased from 8.70 ± 1.68 before surgery to 6.76 ± 1.42 at the 12-month mark. The results indicated significant improvements in glycemic control post-surgery, as evidenced by the marked reduction in HbA1c levels at various time points (1 year, 2 years, etc.) with a p-value of 0.000. In terms of remission, the data showed a distinct result: out of 74 participants, only 20 participants (27%) achieved diabetes remission. Furthermore, seven participants (35%) out of the diabetic remission group experienced a relapse post-intervention and one participant achieved a second diabetes remission. In the assessment of risk factors for relapse, baseline BMI and gender were not strong factors in determining whether a patient experiences diabetes relapse post-surgery. As for weight measurements, the findings showed a steady increase in both Percent Excess Weight Loss (%EWL) and Percent Total Weight Loss (%TWL) in the initial years following surgery with no significant variations across the years, and the p-values were 0.710 and 0.446, respectively. For Percent Weight Regain (%WR), there was a significant and steady increase across the period, with values starting at 6.77 ± 11.8% at Year 2, increasing over the years, and peaking again at 26.64 ± 44.84% by Year 5, with a p-value of < 0.001. Conclusion This study is consistent with previous studies and provides compelling evidence that bariatric surgery leads to substantial improvements in glycemic control and weight reduction among Saudi patients with T2DM. However, it shows a lower percentage of remission in our participants compared to other local and global studies. Further local research is recommended to confirm our findings, analyze the reason for lower rates, and investigate the predictors of remission and relapse. This study fills a crucial gap in localized data, providing insights that could guide future healthcare strategies and improve the management of T2DM in the region.
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Affiliation(s)
- Bader Altulaihi
- Department of Family and Community Medicine, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Riyadh, SAU
- Department of Family Medicine, King Abdulaziz Medical City, Riyadh, SAU
| | - Ali M Sawlan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Nemer A Alwahbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Bandar Alshahrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Yazeed H Alrayani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Yazan H Alrayani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Zhu H, Guo P, Zhao Y, Wu X, Wang B, Yang H, Yu J. Prediction Model of Diabetes Remission at 1-Year after Sleeve Gastrectomy and Comparison with other Models. Obes Surg 2025; 35:249-256. [PMID: 39673018 DOI: 10.1007/s11695-024-07634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 12/04/2024] [Accepted: 12/09/2024] [Indexed: 12/15/2024]
Abstract
BACKGROUND Although numerous prediction models are available for diabetes remission following metabolic bariatric surgery, few are based on sleeve gastrectomy (SG). This study aimed to establish a predictive model for type 2 diabetes mellitus (T2DM) remission following SG and evaluate the efficacy of existing predictive models. METHODS Patient data were gathered from a cohort study titled "Longitudinal Study of Bariatric Surgery in Western China." The synthetic minority oversampling technique was implemented, with 70% randomly selected as the training set and the remaining 30% as the testing set. Univariate logistic regression was used to identify factors associated with T2DM remission. These were included in subsequent stepwise multivariate analyses. A nomogram was then constructed. It was evaluated using a receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis. Finally, eight pre-existing predictive models were validated. RESULTS Initially, 166 patients were enrolled with a T2DM remission rate of 89.2%. Univariate logistic regression indicated that male patients, T2DM duration exceeding 1 year, elevated fasting blood glucose levels, and higher HbA1c levels were less likely to achieve remission 1 year following SG. A nomogram was constructed using variables, including sex, T2DM duration, and HbA1c levels. The ROC curve indicated that the nomogram had higher accuracy (AUC = 0.826, 95%CI: 0.768-0.884). Moreover, the AUCs were 0.790 (95%CI: 0.692-0.887), 0.865 (95%CI: 0.774-0.956) and 0.813 (95%CI: 0.733-0.893) for the testing, externally validated, and raw datasets, respectively. CONCLUSIONS The nomogram exhibited high efficacy in predicting T2DM remission in Chinese patients who underwent SG.
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Affiliation(s)
- Hongmei Zhu
- The Third People's Hospital of Chengdu, Chengdu, China
| | - Peisen Guo
- The Third People's Hospital of Chengdu, Chengdu, China
| | - Yi Zhao
- The Third People's Hospital of Chengdu, Chengdu, China
| | - Xiaolin Wu
- The Third People's Hospital of Chengdu, Chengdu, China
| | - Bing Wang
- The Third People's Hospital of Chengdu, Chengdu, China
| | - Huawu Yang
- The Third People's Hospital of Chengdu, Chengdu, China
| | - Jiahui Yu
- The Third People's Hospital of Chengdu, Chengdu, China.
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Taylor M, Ng D, Pfisterer KJ, Cafazzo JA, Sherifali D. The value of diabetes technology enabled coaching (DTEC) to support remission evaluation of medical interventions in T2D: Patient and health coach perspectives. PLOS DIGITAL HEALTH 2025; 4:e0000701. [PMID: 39787052 PMCID: PMC11717255 DOI: 10.1371/journal.pdig.0000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 11/12/2024] [Indexed: 01/12/2025]
Abstract
The multicomponent Remission Evaluation of Medical Interventions in T2D (REMIT) program has shown reduction of hazard of diabetes relapse by 34-43%, but could benefit from improved ability to scale, spread, and sustain it. This study explored, at the conceptualization phase, patient and health coach perspectives on the acceptability, adoption, feasibility, and appropriateness of a digital REMIT adaptation (diabetes technology enabled coaching (DTEC)). Twelve semi-structured interviews were conducted with patients (n = 6) and health coaches (n = 6) to explore their experiences with the REMIT study, opportunities for virtualisation, and a cognitive walkthrough of solution concepts. Transcripts were analyzed both inductively and deductively to allow for organic themes to emerge and to position these themes around the constructs of acceptability, adoption, feasibility, and appropriateness while allowing new codes to emerge for discussion. Participants saw value in DTEC as: an opportunity to facilitate and extend REMIT support; a convenient, efficient, and scalable concept (acceptability); having potential to motivate through connecting behaviours to outcomes (adoption); an opportunity for lower-effort demands for sustained use (feasibility). Participants also highlighted important considerations to ensure DTEC could provide compassionate insights and support automated data entry (appropriateness). Several considerations regarding equitable access were raised and warrant further consideration including: provision of technology, training to support technology literacy, and the opportunity for DTEC to support and improve health literacy. As such, DTEC may act as a moderator that can enhance or diminish access which affects who can benefit. Provided equity considerations are addressed, DTEC has the potential to address previous shortcomings of the conventional REMIT program.
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Affiliation(s)
- Madison Taylor
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Denise Ng
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Kaylen J. Pfisterer
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Joseph A. Cafazzo
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Habka D, Hsu WC, Antoun J. Economic Evaluation of Fasting Mimicking Diet Versus Standard Care in Diabetic Patients on Dual or Triple Medications at Baseline in the United States: A Cost-Utility Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2025; 28:51-59. [PMID: 39343090 DOI: 10.1016/j.jval.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 07/24/2024] [Accepted: 08/14/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVES According to most guidelines, dietary interventions are essential in the management of diabetes. Fasting has emerged as potential therapeutic regimes for diabetes. The proof-of-concept study and the fasting in diabetes treatment trial are the first to explore the clinical impact of the Fasting Mimicking Diet (FMD) in patients with type 2 diabetes mellitus. Their results showed that FMD cycles improve glycemic management and can be integrated into usual care complementary to current guidelines. This economic evaluation aims to assess the 10-year quality-of-life effects, cost implications, and cost-effectiveness of adding a 3-year FMD program to diabetes standard care in diabetic population on dual or triple medications at baseline from the perspective of the US payer. METHODS We constructed a microsimulation model in TreeAge using a published US-specific diabetes model. The model was populated using FMD effectiveness outcomes and publicly available clinical and economic data associated with diabetes complications, use of diabetes medications, hypoglycemia incidence, direct medical costs in 2021 USD, quality of life, and mortality. All benefits were discounted by 3%. RESULTS This cost-utility analysis showed that the FMD program was associated with 11.4% less diabetes complications, 67.2% less overall diabetes medication use, and 45.0% less hypoglycemia events over the 10-year simulation period. The program generated an additional effectiveness benefit of 0.211 quality-adjusted life year and net monetary benefit of 41 613 USD per simulated patient. Thus, the FMD program is cost saving. CONCLUSIONS These results indicate that the FMD program is a beneficial first-line strategy in T2DM management.
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Raveendran AV. Remission of type 2 diabetes mellitus: Emerging concepts and proposed diagnostic criteria. World J Methodol 2024; 14:95210. [PMID: 39712557 PMCID: PMC11287538 DOI: 10.5662/wjm.v14.i4.95210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/18/2024] [Accepted: 06/13/2024] [Indexed: 07/26/2024] Open
Abstract
The remission of type 2 diabetes mellitus (T2DM) is a topic that has been widely discussed recently, and it gives new hope for people with T2DM. Achievement of normal blood glucose levels or levels below the diagnostic threshold for T2DM without pharmacotherapy among people with T2DM after metabolic surgery and carbohydrate or calorie-restricted diet paved the way for more enthusiastic research in this area. There is a lot of confusion regarding the appropriate terminology and definition of remission of T2DM. In this short review, we briefly analyzed the emerging concepts and proposed criteria for diagnosing remission of T2DM, which will be helpful for healthcare providers and people with T2DM.
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Affiliation(s)
- Arkiath Veettil Raveendran
- Department of Internal Medicine, Former Assistant Professor of Medicine, Govt. Medical College, Kozhikode 673010, Kerala, India
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Noparatayaporn P, Thavorncharoensap M, Chaikledkaew U, Looareesuwan P, Shantavasinkul PC, Sumritpradit P, Thakkinstian A. Cost-utility and budget impact analysis of laparoscopic bariatric surgery for obesity with Type II Diabetes Mellitus in Thailand. PLoS One 2024; 19:e0315336. [PMID: 39656751 DOI: 10.1371/journal.pone.0315336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 11/23/2024] [Indexed: 12/17/2024] Open
Abstract
Bariatric surgery is another treatment options for patients with obesity, who cannot achieve weight controlled by conservative non-surgical therapy. Although bariatric surgery provides clinical benefits for these patients, it is costly. This study aims to evaluate the cost-effectiveness of bariatric surgery, as compared to nonbariatric surgery, in patients with body mass index (BMI) ≥32.5 kg/m2 and type 2 diabetes mellitus (T2DM), and to estimate the budget impact of bariatric surgery in Thailand. METHODS A Markov model was developed to estimate and compare total costs incurred and quality-adjusted life years (QALYs) gained between bariatric surgery and nonbariatric surgery over lifetime horizontal. Analysis was conducted under payer and societal perspectives. Costs and outcomes were discounted at an annual rate of 3%. The outcomes were presented as incremental cost- effectiveness ratio (ICER). RESULTS Under payer's perspective, bariatric surgery resulted in higher total lifetime cost (676,658.39 baht vs 574,683.38 baht) and QALYs gained (16.08 QALYs vs 14.78 QALYs), as compared to nonbariatric surgery, resulting in an ICER of 78,643.02 baht/QALY. Similarly, under the societal perspective, bariatric surgery resulted in higher total lifetime cost (1,451,923.83 baht vs 1,407,590.49 baht) and QALYs gained (16.08 QALYs vs 14.78 QALYs), as compared to nonbariatric surgery. Under societal perspective, ICER was estimated at 34,189.82 baht/QALY. A 5-year budget impact analysis indicated that bariatric surgery incurred the total budget of 223,821 million baht. CONCLUSIONS At the cost-effectiveness threshold of 160,000 baht/QALY, bariatric surgery was a cost-effective strategy and should continue to be included in the benefit package for patients with obesity and T2DM.
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Affiliation(s)
| | - Montarat Thavorncharoensap
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Panu Looareesuwan
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Preeda Sumritpradit
- Trauma, Acute Care Surgery and Surgical Critical Care Unit, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Bangkok, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Sadeghi S, Hosseinpanah F, Khalaj A, Ebadinejad A, Mahdavi M, Valizadeh M, Barzin M. Remission and relapse of diabetes after sleeve gastrectomy and one-anastomosis gastric bypass: The Tehran Obesity Treatment Study. Diabetes Obes Metab 2024; 26:6007-6015. [PMID: 39344845 DOI: 10.1111/dom.15974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 09/08/2024] [Accepted: 09/08/2024] [Indexed: 10/01/2024]
Abstract
AIMS To evaluate the rates and predictors of remission and relapse of type 2 diabetes mellitus (T2DM) in individuals with T2DM undergoing sleeve gastrectomy (SG) or one-anastomosis gastric bypass (OAGB). METHODS An observational prospective study with 5 years of follow-up was conducted in a total of 891 patients (82.5% female) with concomitant T2DM and obesity (body mass index ≥ 30.0 kg/m2) undergoing SG or OAGB between March 2013 and March 2021. T2DM remission was defined as achieving a glycated haemoglobin (HbA1c) level < 48 mmol/mol and a fasting plasma glucose (FPG) level <7 mmol/L, and being off glucose-lowering agents/insulin. T2DM relapse was defined as when FPG or HbA1c reverted to the diabetic range (≥7 mmol/L and ≥48 mmol/mol, respectively), or there was a need for pharmacotherapy. RESULTS After bariatric surgery, the overall T2DM remission and relapse rates were 61.4 per 1000 person-months (95% confidence interval [CI] 56.8-66.4) and 5.7 per 1000 person-months (95% CI 4.1-7.9), respectively. These rates were similar in the SG and OAGB groups. Multivariate hazard ratio analysis identified history of insulin therapy and T2DM duration prior to surgery as predictors of remission, while treatment with ≥2 glucose-lowering agents was the only relapse predictor. Additionally, patients undergoing SG experienced either remission or relapse within a significantly shorter time frame compared to those undergoing OAGB. CONCLUSION After 5 years of follow-up, there were no significant differences between the SG and OAGB groups with regard to T2DM remission and relapse. Bariatric surgery was less likely to result in remission in patients with a history of insulin therapy and longer durations of T2DM prior to surgery. Furthermore, patients who received ≥2 glucose-lowering agents, despite possible remission, were at a higher risk of experiencing late relapse.
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Affiliation(s)
- Sara Sadeghi
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Amir Ebadinejad
- Department of Surgery, Hartford Hospital, Hartford, Connecticut, USA
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Scuffham P, Cross M, Teppala S, Hopkins G, Chikani V, Wykes K, Paxton J. Prioritising patients for publicly funded bariatric surgery in Queensland, Australia. Int J Obes (Lond) 2024; 48:1748-1757. [PMID: 39174748 PMCID: PMC11584382 DOI: 10.1038/s41366-024-01615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 07/15/2024] [Accepted: 08/09/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES This study reports the development and pilot application of the Bariatric Surgery Assessment and Prioritisation Tool (BAPT) for use in a public health system. The BAPT was designed as a patient prioritisation instrument to assess patients with excessive weight and type 2 diabetes suitable for bariatric surgery. We assessed whether the instrument successfully identified those who gained the greatest benefits including weight loss, diabetes remission, reduction in comorbidities, and health-related quality of life (HR-QoL). METHODS The BAPT instrument was applied to score 292 patients referred for bariatric surgery in Queensland between 2017 and 2020 based on their, body mass index, diabetes status, surgical risk (e.g. pulmonary embolism) and comorbidities (e.g. non-alcoholic steatohepatitis). These data were collected at referral and at 12-months post-surgery for 130 patients and stratified by BAPT scores. Outcomes included clinical and HR-QoL. RESULTS Patients' BAPT scores ranged from 12 to 78 (possible range 2-98). Those with higher scores tended to be younger (p < 0.001), have higher BMI (p < 0.001) or require insulin to manage diabetes (p < 0.01). All patients lost similar percentages of body weight (20-25%, p = 0.73) but higher-scoring patients were more likely to discontinue oral diabetes medications (p < 0.001) and the improvement in glycated haemoglobin was four times greater in patients scoring 70-79 points compared to those scoring 20-29 (p < 0.05). Those who scored ≥ 50 on the BAPT were substantially more likely to obtain diabetes remission (57% vs 31%). BAPT scores of 40 and above tended to have greater improvement in HR-QoL. CONCLUSIONS The BAPT prioritised younger patients with higher BMIs who realised greater improvements in their diabetes after bariatric surgery. Higher-scoring BAPT patients should be prioritised for bariatric surgery as they have a greater likelihood of attaining diabetes remission.
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Affiliation(s)
- Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
| | - Megan Cross
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Srinivas Teppala
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - George Hopkins
- Royal Brisbane & Women's Hospital, Queensland Health, Brisbane, QLD, Australia
| | - Viral Chikani
- Endocrinology, Princess Alexandra Hospital, Queensland Health, Brisbane, QLD, Australia
| | - Katie Wykes
- Healthcare Improvement Unit, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia
| | - Jody Paxton
- Healthcare Improvement Unit, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia
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Zambon Azevedo V, Bel Lassen P, Aron-Wisnewsky J, Genser L, Charlotte F, Bedossa P, Ponnaiah M, Pais R, Clément K, Oppert JM, Ratziu V. Metabolic and hepatic phenotypes in sarcopenic obesity and impact of bariatric surgery. Clin Nutr 2024; 43:254-264. [PMID: 39536396 DOI: 10.1016/j.clnu.2024.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 10/25/2024] [Accepted: 10/30/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND & AIMS Sarcopenic obesity (SO) is associated with cardiometabolic disorders and steatotic liver disease and carries major health risks. We assessed the hepatic and metabolic clinical phenotype associated with SO in patients with obesity undergoing bariatric surgery (BS). We also evaluated whether weight-loss and metabolic improvement post-surgery differ between patients with and without SO. METHODS 972 consecutive patients from a single-center BS cohort who underwent whole-body dual-energy X-ray absorptiometry (DXA) and peri-operative liver biopsy were included. SO was diagnosed using the AIM-SO score, an AI-assisted unbiased clustering algorithm based on body composition. One-year post-surgery, 862 patients were reassessed for AIM-SO score changes. RESULTS Pre-operatively, 207 (21.3 %) patients were diagnosed with SO. These patients had significantly higher prevalence of type-2 diabetes (T2D), arterial hypertension and obstructive sleep apnea (OSA) compared to patients without SO (all p ≤ 0.003). Patients with SO had more severe liver damage: higher grades of moderate/advanced steatosis (64.2 % vs. 47.3 %), steatohepatitis (44.4 % vs. 32.3 %) and advanced fibrosis (12.1 % vs. 6.0 %) (all p ≤ 0.01). One-year post-BS, 58.5 % of patients had remission of SO. Patients with persistent SO exhibited less weight-loss than those with SO remission (-23.8 kg vs. -29.1 kg, p < 0.001) and had lower rates of remission for T2D (41.9 % vs. 69.8 %), arterial hypertension (20.8 % vs. 45.3 %), and metabolic syndrome (47.6 % vs. 75.0 %) (all p ≤ 0.009). CONCLUSION The DXA-based AIM-SO score identifies patients with SO who are at greater risk of hepatic and cardiometabolic comorbidities, and predicts less favorable weight-loss and metabolic improvements post-BS.
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Affiliation(s)
- Vittoria Zambon Azevedo
- Sorbonne Université, Paris, France; Foundation for Innovation in Cardiometabolism and Nutrition, IHU ICAN, Paris, France; Centre de Recherche de Cordeliers, INSERM UMRS 1138, Paris, France
| | - Pierre Bel Lassen
- Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches, NutriOmics, Paris, France; Assistance Publique Hôpitaux de Paris, AP-HP, Service de Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | - Judith Aron-Wisnewsky
- Sorbonne Université, Paris, France; Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches, NutriOmics, Paris, France; Assistance Publique Hôpitaux de Paris, AP-HP, Service de Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | - Laurent Genser
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, France
| | - Frederic Charlotte
- Sorbonne Université, Paris, France; Assistance Publique Hôpitaux de Paris, AP-HP, Service d'Anatomie et Cytologie Pathologiques, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Maharajah Ponnaiah
- Foundation for Innovation in Cardiometabolism and Nutrition, IHU ICAN, Paris, France
| | - Raluca Pais
- Foundation for Innovation in Cardiometabolism and Nutrition, IHU ICAN, Paris, France; Assistance Publique Hôpitaux de Paris, AP-HP, Service d'Hépatologie et Gastro-entérologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Karine Clément
- Sorbonne Université, Paris, France; Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches, NutriOmics, Paris, France; Assistance Publique Hôpitaux de Paris, AP-HP, Service de Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Michel Oppert
- Sorbonne Université, Paris, France; Foundation for Innovation in Cardiometabolism and Nutrition, IHU ICAN, Paris, France; Assistance Publique Hôpitaux de Paris, AP-HP, Service de Nutrition, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Vlad Ratziu
- Sorbonne Université, Paris, France; Foundation for Innovation in Cardiometabolism and Nutrition, IHU ICAN, Paris, France; Centre de Recherche de Cordeliers, INSERM UMRS 1138, Paris, France; Assistance Publique Hôpitaux de Paris, AP-HP, Service d'Hépatologie et Gastro-entérologie, Hôpital Pitié-Salpêtrière, Paris, France
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Lins de Souza Salerno M, Garcia Soares Leães Rech C, Bortoluzzi Escobar da Silva P, Weston AC, de Carli LA, Pereira-Lima JF. Eight Year Follow-Up After Gastric Bypass and Sleeve Gastrectomy in a Brazilian Cohort: Weight Trajectory and Health Outcomes. Obes Surg 2024; 34:4452-4458. [PMID: 39461936 DOI: 10.1007/s11695-024-07557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 10/21/2024] [Accepted: 10/22/2024] [Indexed: 10/28/2024]
Abstract
INTRODUCTION Despite Sleeve Gastrectomy (SG) being the most commonly performed bariatric surgery today, studies with over 5 years of follow-up show that patients undergoing SG have inferior weight loss compared to those undergoing Roux-en-Y gastric bypass (RYGB). The aim of this study was to examine differences in weight loss and the prevalence of weight regain between SG and RYGB up to 8 years after surgery. METHODS Retrospective study including adult patients undergoing SG or RYGB between 2015 and 2018 at a tertiary center in Brazil. We evaluate the weight trajectory and pre- and postoperative behavior of type 2 diabetes (T2D), hypertension, and dyslipidemia. Differences betwen variables were tested using Student t-test, Mann-Whitney U, Pearson's chi-square or Fisher's exact test as appropriate. The level of significance adopted was p < 0,005. RESULTS Among 591 patients (40 ± 10 years; baseline body mass index 41.7 [IQR 39.1-45]; 83% women), 327 underwent RYGB (55%) and 264 SG (45%). Preoperatively, 14% had T2D, 40% hypertension, and 53% dyslipidemia. The mean total percentage of weight loss was higher in the RYGB group after 8 years: 32% compared to 19% after SG (difference 13%, p < 0.004). At 8 years, weight regain was also lower in RYGB (23%) compared to SG (39%) (p < 0.001). At 5 years postoperatively, the remission rates for T2D, hypertension, and dyslipidemia were 63%, 42%, and 51%, respectively, among the patients who remained in follow-up. CONCLUSIONS Patients undergoing RYGB showed greater weight loss and less weight regain 8 years after bariatric surgery compared to those undergoing SG.
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Affiliation(s)
- Marianna Lins de Souza Salerno
- Graduate Program in Pathology at the Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil.
- Obesity Treatment Center, Hospital Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 155 - Independência, Porto Alegre, RS, 90035-074, Brazil.
| | - Carolina Garcia Soares Leães Rech
- Obesity Treatment Center, Hospital Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 155 - Independência, Porto Alegre, RS, 90035-074, Brazil
- Undergraduate Medicine Program at the Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil
| | - Pedro Bortoluzzi Escobar da Silva
- Undergraduate Medicine Program at the Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil
| | - Antonio Carlos Weston
- Obesity Treatment Center, Hospital Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 155 - Independência, Porto Alegre, RS, 90035-074, Brazil
| | - Luis Alberto de Carli
- Obesity Treatment Center, Hospital Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 155 - Independência, Porto Alegre, RS, 90035-074, Brazil
| | - Julia Fernanda Pereira-Lima
- Graduate Program in Pathology at the Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil
- Undergraduate Medicine Program at the Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil
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Kermansaravi M, Chiappetta S, Kassir R, Bosco A, Giudicelli X, Lainas P, Safieddine M. Efficacy of One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for the Treatment of Type 2 Diabetes Mellitus: a Systematic Review and Meta-Analysis of Randomized Clinical Trials. Obes Surg 2024; 34:4555-4562. [PMID: 39496986 DOI: 10.1007/s11695-024-07564-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 10/13/2024] [Accepted: 10/26/2024] [Indexed: 11/06/2024]
Abstract
The worldwide prevalence of type 2 diabetes mellitus (T2DM) is increasing in parallel with obesity. One anastomosis gastric bypass (OAGB) is considered effective to treat both T2DM and obesity. The aim of this study was to evaluate the efficacy of OAGB versus sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for treatment of T2DM, analyzing data exclusively from randomized control trials (RCTs). Α systematic review of published RCTs comparing OAGB versus RYGB or SG (control groups) in T2DM patients regarding diabetes remission and weight loss was performed. Primary endpoints were T2DM remission rate and 1-year and 5-year % weight loss postoperatively. Initial search identified 39 references, of which 8 RCTs were considered eligible for meta-analysis inclusion, comprising 636 patients (311 OAGB, 122 RYGB, 203 SG patients). Main meta-analysis findings were: i) higher 1-year %EWL for OAGB than control group (p = 0.04); ii) higher 5-year %EWL for OAGB than control group (p < 0.01); iii) no difference in 1-year remission rate of T2DM between OAGB and control group (p = 0.14); iv) 28% higher 5-year remission rate of T2DM for OAGB than control group (p < 0.01). OAGB had statistically significant better outcomes compared to RYGB and SG regarding T2DM remission and %EWL at 5 years. Further pathophysiologic studies are needed to indicate the most potent bariatric procedure in patients with T2DM and obesity.
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Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Minimally Invasive Surgery Research Center, Hazrat-E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Sonja Chiappetta
- Department of General Surgery, Center of Excellence for Bariatric and Metabolic Surgery, Ospedale Evangelico Betania, Naples, Italy.
| | - Radwan Kassir
- Department of General Surgery, The View Hospital, University of Qatar, Doha, Qatar
| | - Alfonso Bosco
- Department of General Surgery, Center of Excellence for Bariatric and Metabolic Surgery, Ospedale Evangelico Betania, Naples, Italy
| | - Xavier Giudicelli
- Department of Hepatobiliary & Digestive Surgery, Rennes University Hospital, Rennes, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive & Bariatric Surgery, Metropolitan Hospital, Athens, Greece.
| | - Maissa Safieddine
- Clinical Research Center, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Raithatha D, Sen P, Dave C, Yadav V, Mahapatra A, Shukla R, Bajpai A. Determinants of Course of Type 2 Diabetes in Indian Adolescents. Indian J Pediatr 2024; 91:1244-1249. [PMID: 38829540 DOI: 10.1007/s12098-024-05157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES To identify determinants of the course of Type 2 diabetes in Indian adolescents. METHODS Records of 37 adolescents (24 boys; 29 post pubertal and eight pubertal) with Type 2 diabetes (initial HbA1C 10.1 ± 1.9% and BMI SDS 2.0 ± 0.8; family history of diabetes in 33, 89.2%) diagnosed at 15.2 ± 2.5 y and followed up for 3.8 ± 2.2 y till 19.1 ± 3.3 y of age, were reviewed. RESULTS Initial treatment included insulin in 11 (29.7%), metformin alone in 22 (59.5%), and a combination of anti-diabetic medication in four (10.8%). Eleven subjects (29.7%) achieved remission at a median period of 5.3 mo (IQR- 17.13) after diagnosis; six of these relapsed within 0.9 ± 0.3 (range 0.4-1.3) y. The proportion of subjects requiring multiple anti-diabetic agents increased over follow-up (19% at six months, 32.5% at one year, 50% at two years, 59.1% at three, and 64.8% at four years), with the need for combination therapy after 0.9 ± 1.4 y. At the last follow-up, five were off treatment (13.5%), 10 (27%) were on metformin alone, and 22 (59.5%) were on multiple medications. The need for combination therapy at the last follow-up was lower in subjects with remission (27% against 73.1%, p = 0.02). CONCLUSIONS The findings of this study suggest delayed presentation and rapid progression of Type 2 diabetes in Indian adolescents. Diagnosis on screening and achievement of remission were predictors of good outcome.
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Affiliation(s)
- Dhvani Raithatha
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, 208001, India
| | - Proteek Sen
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, 208001, India
| | - Chetankumar Dave
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, 208001, India
| | - Vibha Yadav
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, 208001, India
| | - Alapan Mahapatra
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, 208001, India
| | - Rishi Shukla
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, 208001, India
| | - Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, 208001, India.
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Wormall S, Richardson K. Proactive total diet replacement referral for type 2 diabetes: A service evaluation. Prim Care Diabetes 2024; 18:669-675. [PMID: 39488467 DOI: 10.1016/j.pcd.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 10/07/2024] [Accepted: 10/13/2024] [Indexed: 11/04/2024]
Abstract
AIMS Type 2 Diabetes Mellitus morbidity disproportionally effects the most socioeconomically deprived 20 % of England. Total Diet Replacement (TDR) is a high impact intervention currently commissioned by Integrated Care Boards (ICB). Finding and referring eligible, motivated patients is a significant challenge. This study evaluates a 12-month population health management, proactive referral intervention commissioned by Nottingham and Nottinghamshire ICB during a 2-year TDR pilot designed to supplement referrals from primary care. METHODS A Diabetes specialist nurse clinically reviewed a list of potentially eligible patients found by searching routinely collected health care data from 16 primary care centres in 3 PCNs. RESULTS 19.7 % (50/254) of potential patients were referred during the intervention period. 19.3 % (49/254) were uncontactable. 39.8 % (101/254) declined referral. 17.7 % (45/254) were ineligible after clinical review. An interrupted time series analysis suggests monthly referrals increased during the study period due to the intervetion (F (1,22) = 5.19 p=0.0345). Searching for patients from more socioeconomically deprived areas (index of multiple deprivation deciles 1-3) did not meaningfully alter the referral yield (19.6 %, 19/97). CONCLUSIONS Proactive care interventions could be used to facilitate referrals to the TDR or other high impact interventions by healthcare commissioning bodies.
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Osorio Manyari AA, Armas Alvarez AL, Osorio Manyari JD, Caballero FG, Pouwels S. "Metabolic surgery in Asian patients with type 2 diabetes mellitus and body mass index less than 30kg/m2: A systematic review". OBESITY PILLARS 2024; 12:100145. [PMID: 39507886 PMCID: PMC11538796 DOI: 10.1016/j.obpill.2024.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 10/14/2024] [Accepted: 10/18/2024] [Indexed: 11/08/2024]
Abstract
Background The effect of metabolic surgery on long-term diabetes remission in Asian patients with a body mass index (BMI) < 30 kg/m2 has not been widely reported. Methods We conducted a systematic review of the PubMed and Cochrane Library databases from inception to June 2024. All clinical trials and observational studies involving the effect of metabolic surgery in Asian patients with type 2 diabetes mellitus and BMI <30 kg/m2 were considered. The quality of the studies was assessed using the Newcastle-Ottawa scale. Results Of the 1175 studies screened, 21 studies (11 prospective and 10 retrospective), including 1005 patients, were selected. Only one study had a control group. The longest follow-up was 60 months. The results showed significant improvement in glycated hemoglobin (HbA1c), fasting blood glucose (FBG), 2-h plasma glucose (2hPG), homeostasis model assessment for insulin resistance index (HOMA-IR), fasting C-peptide, triglycerides, total cholesterol, and a reduction in the use of oral hypoglycemic agents/insulin at 12, 24, 36, and 60 months after metabolic surgery. The most common surgical complications observed were anemia (2.1 %-33 %), marginal ulcer (4.2 %-17.3 %), gastrointestinal bleeding (1.9 %-12 %), anastomotic leak (2.1 %-3.5 %), anastomotic stenosis (2.1 %-3.5 %), reoperation (1.18 %), and a mortality rate of zero. Conclusions Long-term diabetes remission, along with improvements in HbA1c, 2hPG, FBG, and HOMA-IR, with an acceptable rate of complications, was observed in Asian patients with BMI <30 kg/m2 after metabolic surgery. Future research with controlled studies should focus on preoperative patient selection criteria beyond just the BMI cutoff.
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Affiliation(s)
- Angel Alois Osorio Manyari
- Service of Surgery, Hospital Don Benito-Villanueva, Ctra. Don Benito-Villanueva s/n, 06400, Don Benito, Villanueva, Spain
| | - Azucena Lirio Armas Alvarez
- Service of Urology, Hospital Don Benito-Villanueva, Ctra. Don Benito-Villanueva s/n, 06400, Don Benito, Villanueva, Spain
| | | | - Francisco Gonzalez Caballero
- Service of Surgery, Hospital Don Benito-Villanueva, Ctra. Don Benito-Villanueva s/n, 06400, Don Benito, Villanueva, Spain
| | - Sjaak Pouwels
- Department of Surgery, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Herne, NRW, Germany
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
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Abu-Abeid A, Gosher N, Shnell M, Fishman S, Keidar A, Lahat G, Eldar SM. Revision of restrictive bariatric procedures in elderly patients: results at a 5-year follow-up. Updates Surg 2024; 76:2825-2831. [PMID: 38796821 PMCID: PMC11628429 DOI: 10.1007/s13304-024-01888-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/18/2024] [Indexed: 05/29/2024]
Abstract
Revisional Bariatric Surgery (RBS) is increasing in popularity. Elderly patients (> 65 years old) are sometimes referred for RBS evaluation. The aim of this study is to evaluate outcomes of elderly patients undergoing RBS. A retrospective analysis of a cohort from a single-tertiary bariatric center. All elderly patients undergoing RBS after restrictive procedures between 2012 and 2022 were included. Thirty Nine patients undergoing RBS were included in the comparative analysis - 23 patients (57.5%) after adjustable gastric banding (s/p LAGB) and 16 patients (40%) after Sleeve Gastrectomy (s/p SG). The mean age and body mass index (BMI) of patients were comparable (67.2 ± 2.8 years and 38.3 ± 7.4, respectively). There was no difference in associated medical problems except reflux which was higher in s/p SG (68% vs. 13%; p < 0.001). The mean time interval between surgeries was 8.7 ± 5.1 years. The surgeries included One anastomosis gastric bypass (n = 22), SG (n = 8) and Roux-en-y gastric bypass (n = 9). Early major complication rates were comparable (4.3% and 12.5%; p = 0.36), and readmission rate was higher in patients s/p SG (p = 0.03). Ninety percent of patients were available to a follow-up of 59.8 months. The mean BMI and total weight loss was 29.2 and 20.3%, respectively with no difference between groups. The rate of patients with associated medical problems at last follow-up was significantly reduced. Five patients (12.5%) underwent revisional surgery due to complications during follow-up. In conclusion, RBS in the elderly is associated with a reasonable complication rate and is effective in terms of weight loss and improvement of associated medical problems in a 5-year follow-up.
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Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel.
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noa Gosher
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Mati Shnell
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Fishman
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrei Keidar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Meron Eldar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Punthakee Z, Hall S, McInnes N, Sherifali D, Tsiplova K, Kirabo FR, Ransom TPP, Harris SB, Lochnan HA, Sigal RJ, Ghosh M, Spaic T, Gerstein HC. Evaluating remission of type 2 diabetes using a metabolic intervention including fixed-ratio insulin degludec and liraglutide: A randomized controlled trial. Diabetes Obes Metab 2024; 26:5600-5608. [PMID: 39239702 DOI: 10.1111/dom.15926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 09/07/2024]
Abstract
AIM To evaluate the effect on type 2 diabetes remission of short-term intensive metabolic intervention consisting of frequent dietary, exercise and diabetes management coaching, metformin and fixed-ratio insulin degludec/liraglutide. METHODS In a multicentre open-label randomized controlled trial, insulin-naïve participants within 5 years of diabetes diagnosis were assigned to a 16-week remission intervention regimen or standard care, and followed for relapse of diabetes and sustained remission for an additional year after stopping glucose-lowering drugs. RESULTS A total of 159 participants aged 57 ± 10 years, with diabetes duration 2.6 ± 1.5 years, body mass index 33.5 ± 6.5 kg/m2, and glycated haemoglobin (HbA1c) level 53 ± 7 mmol/mol were randomized and analysed (79 intervention, 80 control). At the end of the 16-week intervention period, compared to controls, intervention participants achieved lower HbA1c levels (40 ± 4 vs. 51 ± 7 mmol/mol; p < 0.0001), and lost more weight (3.3 ± 4.4% vs. 1.9 ± 3.0%; p = 0.02). There was a lower hazard of diabetes relapse overall in the intervention group compared to controls (hazard ratio 0.63, 95% confidence interval [CI] 0.45, 0.88; p = 0.007), although this was not sustained over time. Remission rates in the intervention group were not significantly higher than in the control group at 12 weeks (17.7% vs. 12.5%, relative risk [RR] 1.42, 95% CI 0.67, 3.00; p = 0.36) or at 52 weeks (6.3% vs. 3.8%, RR 1.69, 95% CI 0.42, 6.82) following the intervention period. CONCLUSIONS An intensive remission-induction intervention including fixed-ratio insulin degludec/liraglutide reduced the risk of type 2 diabetes relapse within 1 year without sustained remission.
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Affiliation(s)
- Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Stephanie Hall
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Natalia McInnes
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Diana Sherifali
- Population Health Research Institute, Hamilton, Ontario, Canada
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Kate Tsiplova
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Faith R Kirabo
- Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - Stewart B Harris
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Heather A Lochnan
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Ronald J Sigal
- Department of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mahua Ghosh
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Tamara Spaic
- Department of Medicine, Western University and Lawson Health Research Institute, London, Ontario, Canada
| | - Hertzel C Gerstein
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
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