Skip to main content
SpringerLink
Log in

Role of Metabolic Surgery in Less Obese or Non-Obese Subjects with Type 2 Diabetes: Influence Over Cardiovascular Events

  • Lipid and Metabolic Effects of Gastrointestinal Surgery (FR Rubino, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Bariatric surgery was initially developed as a tool for weight reduction only, but it is gaining increasing popularity because of its remarkable effect on glucose metabolism in morbidly obese and less obese patients. Recent publications have shown the good results of metabolic surgery, creating a new field of clinical research that is currently overflowing in the medical community with outstanding high-quality data. In morbidly obese population, there is compelling data on long term cardiovascular risk reduction and mortality, coming from longitudinal prospective studies and systematic reviews. Numbers range from 33 to 92 % of decrease in fatal and nonfatal cardiovascular events . In low body mass index (BMI) diabetics, there is an increasing number of reported good outcomes after metabolic surgery with the aim to treat type 2 diabetes (T2DM). There is scarce information on cardiovascular outcomes in non–morbidly obese subjects, but the extraordinary glucose, lipid and blood pressure control in the published series are suggesting good long-term effects on cardiovascular risk profile and mortality. The papers review was comprehensive, including the available randomized controlled trials, long-term prospective series and systematic reviews.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033–46.

    Article  Google Scholar 

  2. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.

    Article  PubMed  Google Scholar 

  3. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94:311–21.

    Article  PubMed  Google Scholar 

  4. Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. NEJM. 2003;348:383–93.

    Article  PubMed  Google Scholar 

  5. Murray P, Chune GW, Raghavan VA. Legacy effects from DCCT and UKPDS: what they mean and implications for future diabetes trials. Curr Atheroscler Rep. 2010;12:432–9.

    Article  PubMed  Google Scholar 

  6. Gaede P, Lund-Andersen H, Parving H-H, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. New Engl J Med. 2008;358:580–91.

    Article  PubMed  CAS  Google Scholar 

  7. American Diabetes Association. Standards of medical care in diabetes 2011. Diabetes Care. 2011;34:S11–61.

    Article  Google Scholar 

  8. • Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010. Diabetes Care. 2013;(in press). doi:10.2337/dc12-2258. Recent report on the “3 endpoints” results achieved in T2DM treatment.

  9. Grant RW, Buse JB, Meigs JB, University Health System Consortium (UHC) Diabetes Benchmarking Project Team. Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change. Diabetes Care. 2005;28:337–442.

    Article  PubMed  Google Scholar 

  10. Cohen R, Caravatto PP, Petry T. Surgery for Diabetes. Curr Surg Rep. 2013;(in press). doi:10.1007/s40137-013-0023-0.

  11. Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365:1597–604.

    Article  PubMed  CAS  Google Scholar 

  12. • Cohen R, Caravatto PP, Petry Z. Metabolic surgery for type 2 diabetes in patients with a BMI of <35 kg/m2: a Surgeon’s perspective. Obes Surg. 2013;23:809–18. A comprehensive review of metabolic surgery in BMIs below 35 kg/m 2.

    Article  PubMed  Google Scholar 

  13. Shah SS, Todkar JS, Shah PS, et al. Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index. Surg Obes Relat Dis. 2010;6:332–8.

    Article  PubMed  Google Scholar 

  14. Cohen RV, Rubino F, Schiavon C, et al. Diabetes remission without weight loss after duodenal bypass surgery. Surg Obes Relat Dis. 2011;8:66–8.

    Article  Google Scholar 

  15. Cohen RV, Schiavon CA, Pinheiro Filho JC, et al. Laparoscopic bariatric surgery: new technologies, trends and perspectives. Rev Hosp Clin Fac Med Sao Paulo. 2003;58:I–VIII.

    Article  PubMed  Google Scholar 

  16. Geloneze B, Geloneze SR, Chaim E, et al. Metabolic surgery for non-obese type 2 diabetes: incretins, adipocytokines, and insulin secretion/resistance changes in a 1-year interventional clinical controlled study. Ann Surg. 2012;256:72–8.

    Article  PubMed  Google Scholar 

  17. DePaula AL, Macedo ALV, Rassi N, et al. Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35. Surg Endosc. 2007;22:706–16.

    Article  Google Scholar 

  18. Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis. Diabetes Care. 2008;31:S290–6.

    Article  PubMed  Google Scholar 

  19. Cummings DE, Flum DR. Gastrointestinal surgery as a treatment for diabetes. JAMA. 2008;299:341–3.

    Article  PubMed  CAS  Google Scholar 

  20. Yamaoka K, Tango T. Efficacy of lifestyle education to prevent type 2 diabetes: a meta-analysis of randomized controlled trials. Diabetes Care. 2005;28:2780–6.

    Article  PubMed  Google Scholar 

  21. Li Q, Chen L, Yang Z, et al. Metabolic effects of bariatric surgery in type 2 diabetic patients with body mass index. Diabetes Obes Metab. 2011;14:262–70.

    Article  PubMed  Google Scholar 

  22. •• Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65. Landmark paper that analyses cardiovascular outcomes after 20 years follow up. Shows that the ony CV predicting factor was fasting insuli and not BMI.

    Article  PubMed  Google Scholar 

  23. Bianchi C, Del Prato S. Metabolic memory and individual treatment aims in type 2 diabetes outcome – lessons learned from large clinical trials. Rev Diabet Stud. 2011;8:432–40.

    Article  PubMed  Google Scholar 

  24. Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk for complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.

  25. Look AHEAD Group. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD Trial. Arch Intern Med. 2010;170:1566–75.

    Article  Google Scholar 

  26. Gregg EW, Chen H, Wagenknecht LE, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308:2489–96.

    Article  PubMed  CAS  Google Scholar 

  27. • Arterburn DE, Bogart A, Sherwood NE, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2012;23:93–102. Interesting paper that analyses the long term effects of bariatric surgery & T2DM.

    Article  Google Scholar 

  28. Arterburn DE, O’Connnor PJ. A look ahead at the future of diabetes prevention and treatment. JAMA. 2012;308:2517–9.

    Article  PubMed  CAS  Google Scholar 

  29. Rubino F. Bariatric surgery: effects on glucose homeostasis. Curr Opin Clin Nutr Metab Care. 2006;9:497–507.

    Article  PubMed  CAS  Google Scholar 

  30. Rubino F, Marescaux J. Effect of duodenal–jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239:1–11.

    Article  PubMed  Google Scholar 

  31. Cohen RV, Schiavon CA, Pinheiro JS, et al. Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22–34 kg/m2: a report of 2 cases. Surg Obes Relat Dis. 2007;3:195–7.

    Article  PubMed  Google Scholar 

  32. Cohen R, Caravatto PP, Correa JL, et al. Glycemic control after stomach-sparing duodenal-jejunal bypass surgery in diabetic patients with low body mass index. Surg Obes Relat Dis. 2012;8:375–80.

    Article  PubMed  Google Scholar 

  33. Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93:2479–85.

    Article  PubMed  Google Scholar 

  34. • Cohen R, Pinheiro JC, Schiavon CA, et al. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care. 2012;35:1420–8. Longest follow up of bariatric surgery in BMIs < 35.

    Article  PubMed  Google Scholar 

  35. Kim S, Richards WO. Long-term follow-up of the metabolic profiles in obese patients with type 2 diabetes mellitus after Roux-en-Y gastric bypass. Ann Surg. 2010;251:1049–55.

    Article  PubMed  Google Scholar 

  36. Asztalos BF, Swarbrick MM, Schaefer EJ, et al. Effects of weight loss, induced by gastric bypass surgery, on HDL remodeling in obese women. J Lipid Res. 2010;51:2405–12.

    PubMed  CAS  Google Scholar 

  37. Voight BF, Peloso GM, Orho-Melander M, et al. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. Lancet. 2012;380:572–80.

    Article  PubMed  CAS  Google Scholar 

  38. Prati P, Vanuzzo D, Casaroli M, et al. Prevalence and determinants of carotid atherosclerosis in a general population. Stroke. 1992;23:1705–11.

    Article  PubMed  CAS  Google Scholar 

  39. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.

    Article  PubMed  CAS  Google Scholar 

  40. Carlsson LM, Peltonen M, Ahlin S, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367:695–704.

    Article  PubMed  CAS  Google Scholar 

  41. Romeo S, Maglio C, Burza MA, et al. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care. 2012;35:2613–7.

    Article  PubMed  CAS  Google Scholar 

  42. Heneghan HM, Meron-Eldar S, Brethauer SA, Schauer PR, Young JB. Effect of bariatric surgery on cardiovascular risk profile. AJC. 2011;108(10):1499–507.

    Article  Google Scholar 

  43. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98(24):1763–1777.

  44. •• Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery vs. intensive medical therapy in obese patients with diabetes. New Engl J Med. 2012;366:1567–76.

    Article  PubMed  CAS  Google Scholar 

  45. •• Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. New Engl J Med. 2012;366:1577–85. First 2 RCTs that compared surgery versus medical treatment focusing T2DM.

    Article  PubMed  CAS  Google Scholar 

  46. Maggard-Gibbons M, Maglione M, Livhits M, Ewing B, Maher AR, Hu J, et al. Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review. JAMA. 2013;309(21):2250–61.

    Article  PubMed  CAS  Google Scholar 

  47. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes. A randomized controlled trial. JAMA. 2008;299:316–23.

    Article  PubMed  CAS  Google Scholar 

  48. Sultan S, Parikh M, Youn H, Kurian M, Fielding G, Ren C. Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2. Surg Endosc. 2009;23:1569–73.

    Article  PubMed  Google Scholar 

  49. Lee WJ, Ser KH, Chong K, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion. Surgery. 2010;147:664–9.

    Article  PubMed  Google Scholar 

  50. Lee WJ, Hur KY, Lakadawala M, et al. Gastrointestinal metabolic surgery for the treatment of diabetic patients: a multi-institutional international study. J Gastrointest Surg. 2012;16:45–52.

    Article  PubMed  Google Scholar 

  51. Abbatini F, Capoccia D, Casella G, et al. Type 2 diabetes in obese patients with body mass index of 30–35 kg/m2: sleeve gastrectomy versus medical treatment. Surg Obes Relat Dis. 2012;8:20–4.

    Article  PubMed  Google Scholar 

  52. Lee WJ, Chong K, Chen CY, et al. Diabetes remission and insulin secretion after gastric bypass in patients with body mass index < 35kg/m2. Obes Surg. 2011;21:889–95.

    Article  PubMed  Google Scholar 

  53. Scopinaro N, Adami GF, Papadis FS, et al. Effects of biliopanceratic diversion on type 2 diabetes in patients with BMI 25 to 35. Ann Surg. 2011;253:699–703.

    Article  PubMed  Google Scholar 

  54. Chellini C, Rubino F, Castagneto M, et al. The effect of bilio-pancreatic diversion on type 2 diabetes in patients with BMI < 35 kg/m2. Diabetologia. 2009;52:1027–30.

    Article  Google Scholar 

Download references

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. The Center of Excellence of Metabolic and Bariatric Surgery, Oswaldo Cruz Hospital, São Paulo, Brazil

    Ricardo Cohen, Pedro Paulo Caravatto & Tarissa Petry

  2. Diabetes and Obesity Center of Excellence and Veterans Affairs Puget Sound Health Care System, University of Washington School of Medicine, Seattle, WA, USA

    David Cummings

Authors
  1. Ricardo Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pedro Paulo Caravatto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tarissa Petry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Cummings
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ricardo Cohen.

Additional information

This article is part of the Topical Collection on Lipid and Metabolic Effects of Gastrointestinal Surgery

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cohen, R., Caravatto, P.P., Petry, T. et al. Role of Metabolic Surgery in Less Obese or Non-Obese Subjects with Type 2 Diabetes: Influence Over Cardiovascular Events. Curr Atheroscler Rep 15, 355 (2013). https://doi.org/10.1007/s11883-013-0355-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-013-0355-3

Keywords

Search

Navigation