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Interventional Diabetology: The Evolution of Diabetes Care in the XXI Century

  • Lipid and Metabolic Effects of Gastrointestinal Surgery (F Rubino, Section Editor)
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Abstract

It has been observed that bariatric surgery, in addition to its profound weight-reduction effects, leads to a durable resolution of type 2 diabetes. This supports the possibility that a cure for this disease may be obtainable, both by surgery as well as with drugs or devices that mimics the effects of surgery’. Elucidating the mechanisms underlying the beneficial effects of gastrointestinal surgery may also facilitate understanding of the elusive etiology of this condition. Current evidence supports a role for surgical interventions in the treatment algorithm of obese patients with type 2 diabetes, while a number of device-based gastrointestinal interventions are now being investigated as novel and less invasive alternatives. Interventional diabetology could be defined by the use and study of traditional surgical options and novel, gastrointestinal device‐ based interventions for diabetes. In this manuscript, we discuss how the introduction of interventional diabetology may shape the way we approach diabetes in the 21st century.

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References

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

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

    Article  PubMed  Google Scholar 

  2. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14.

    Article  PubMed  CAS  Google Scholar 

  3. Rubino F, Schauer PR, Kaplan LM, et al. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med. 2010;61:393–411.

    Article  PubMed  CAS  Google Scholar 

  4. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.

    Article  PubMed  CAS  Google Scholar 

  5. • Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65. Sjöström et al. recently demonstrated that bariatric surgery was associated with a reduced number of cardiovascular deaths among the surgery group compared to the control group (28 events among 2010 patients vs 49 events among 2037 patients respectively; p = .002).

    Article  PubMed  Google Scholar 

  6. Pacheco D, de Luis DA, Romero A, et al. The effects of duodenal-jejunal exclusion on hormonal regulation of glucose metabolism in Goto-Kakizaki Rats. Am J Surg. 2007;194(2):221–4.

    Article  PubMed  CAS  Google Scholar 

  7. Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244(5):741–9.

    Article  PubMed  Google Scholar 

  8. O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144(9):625–33.

    PubMed  Google Scholar 

  9. Cohen R, Pinheiro JS, Correa JL, et al. Laparoscopic Roux-en-Y gastric bypass for BMI <35 kg/m2: a tailored approach. Surg Obes Relat Dis. 2006;2(5):579–80.

    Article  PubMed  Google Scholar 

  10. Lee WJ, Wang W, Lee YC. Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI > 35 and <35 kg/m2. J Gastrointest Surg. 2008;12(5):945–52.

    Article  PubMed  Google Scholar 

  11. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236(5):554–9.

    Article  PubMed  Google Scholar 

  12. Angervall L, dotevall G, Tillander H. Amelioration of diabetes mellitus following gastric resection. Acta Med Scand. 1961;169:743–48.

    Article  PubMed  CAS  Google Scholar 

  13. Rubino F, Kaplan LM, Schauer PR, et al. Diabetes Surgery Summit Delegates. The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg. 2010;251(3):399–405.

    Article  PubMed  Google Scholar 

  14. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32 Suppl 1:S13–61.

    Article  Google Scholar 

  15. • Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese Type 2 diabetes. Diabet Med. 2011;28(6):628–42. The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened, suggesting that bariatric surgery can be considered an appropriate treatment for patients with type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies.

    Article  PubMed  CAS  Google Scholar 

  16. • Dixon JB, le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet. 2012;379(9833):2300–11. Dixon et al. stated that the uptake of surgery in patients who are eligible is poor, and that increased research is currently being conducted in this field. It is clear that surgery has weight-independent mechanisms, and by understanding this can provide insights into the understanding of the pathogenesis of type 2 diabetes and thus being able to assist in the development of new treatment strategies for type 2 diabetes.

    Article  PubMed  Google Scholar 

  17. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.

    Article  PubMed  Google Scholar 

  18. Razak F, Anand SS, Shannon H, et al. Defining obesity cut points in a multiethnic population. Circulation. 2007;115(16):2111–8.

    Article  PubMed  Google Scholar 

  19. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.

    Article  Google Scholar 

  20. Low S, Chin MC, Ma S, et al. Rationale for redefining obesity in Asians. Ann Acad Med Singapore. 2009;38(1):66–9.

    PubMed  Google Scholar 

  21. Stevens J, Truesdale KP, Katz EG, et al. Impact of body mass index on incident hypertension and diabetes in Chinese Asians, American Whites, and American Blacks: the People’s Republic of China Study and the Atherosclerosis Risk in Communities Study. Am J Epidemiol. 2008;167(11):1365–74.

    Article  PubMed  Google Scholar 

  22. Pories WJ, Dohm LG, Mansfield CJ. Beyond the BMI: the search for better guidelines for bariatric surgery. Obesity (Silver Spring). 2010;18(5):865–71.

    Article  Google Scholar 

  23. Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.

    Article  PubMed  Google Scholar 

  24. Shukla AP, Ahn SM, Patel RT, et al. Surgical treatment of type 2 diabetes: the surgeon perspective. Endocrine. 2011;40(2):151–61. Shukla et al. described how the safety and cost-effectiveness of bariatric surgery has been well established, thus, the available evidence warrants the inclusion of metabolic surgery in the treatment algorithm of type 2 diabetes.

    Article  PubMed  CAS  Google Scholar 

  25. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84.

    PubMed  Google Scholar 

  26. Kadera BE, Lum K, Grant J, Pryor AD, et al. Remission of type 2 diabetes after Roux-en-Y gastric bypass is associated with greater weight loss. Surg Obes Relat Dis. 2011;7(6):691–6.

    Article  Google Scholar 

  27. • Pournaras DJ, Aasheim ET, Søvik TT, et al. Effect of the definition of type II diabetes remission in the evaluation of bariatric surgery for metabolic disorders. Br J Surg. 2012;99(1):100–3. Pournaras et al. stated how the remission rate for gastric bypass was significantly lower with the new definition than with the previously used definition, thus the expectations of patients and clinicians may have to be adjusted in terms of the remission of type 2 diabetes post bariatic surgery.

    Article  PubMed  CAS  Google Scholar 

  28. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  30. Shukla AP, Moreira M, Dakin G, et al. Medical versus surgical treatment of type 2 diabetes: the search for level 1 evidence. Surg Obes Relat Dis. 2012;8(4):476–82.

    Article  PubMed  Google Scholar 

  31. Schauer P, Chand B, Brethauer S. New applications for endoscopy: the emerging field of endoluminal and transgastric bariatric surgery. Surg Endosc. 2007;21(3):347–56.

    Article  PubMed  CAS  Google Scholar 

  32. • Breen DM, Rasmussen BA, Kokorovic A, et al. Jejunal nutrient sensing is required for duodenal-jejunal bypass surgery to rapidly lower glucose concentrations in uncontrolled diabetes. Nat Med. 2012;18(6):950–5. Breen et al. demonstrated that the repositioned jejunum after a DJB represents a junction at which nutrients could regulate glucose homeostasis. Their data showed the glucoregulatory role of jejunal nutrient sensing and its relevance in the early improvement of glycemic control after DJB in rat models of uncontrolled diabetes.

    Article  PubMed  CAS  Google Scholar 

  33. Aguirre V, Stylopoulos N, Grinbaum R, et al. An endoluminal sleeve induces substantial weight loss and normalizes glucose homeostasis in rats with diet-induced obesity. Obesity. 2008;16:2585–92.

    Article  PubMed  CAS  Google Scholar 

  34. Tarnoff M, Rodriguez L, Escalona A, et al. Open label, prospective, randomized controlled trial of an endoscopic duodenal-jejunal bypass sleeve versus low calorie diet for pre-operative weight loss in bariatric surgery. Surg Endosc. 2009;23(3):650–65.

    Article  PubMed  CAS  Google Scholar 

  35. Wang PY, Caspi L, Lam CK, et al. Upper intestinal lipids trigger a gut-brain-liver axis to regulate glucose production. Nature. 2008;452(7190):1012–6.

    Article  PubMed  CAS  Google Scholar 

  36. Bohdjalian A, Prager G, Rosak C, et al. Improvement in glycemic control in morbidly obese type 2 diabetic subjects by gastric stimulation. Obes Surg. 2009;19(9):1221–7.

    Article  PubMed  Google Scholar 

  37. Rubino F, R’bibo SL, del Genio F, et al. Metabolic surgery: the role of the gastrointestinal tract in diabetes mellitus. Nat Rev Endocrinol. 2010;6(2):102–9.

    Article  PubMed  Google Scholar 

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Disclosure

FR received research grant from Covidien; honoraria for lectures from Ethicon and serves as scientific advisory board member of NGM Biopharmaceuticals. Other authors have no disclosures.

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Authors and Affiliations

  1. Section of GI Metabolic Surgery; Department of Surgery, Weill Cornell Medical College- New York Presbyterian Hospital, 525 East 68th Street, P-714, New York, NY, 10065, USA

    Ashwin Soni, Alpana P. Shukla & Francesco Rubino

  2. Catholic University of Rome, Rome, Italy

    Francesco Rubino

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  1. Ashwin Soni
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  2. Alpana P. Shukla
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  3. Francesco Rubino
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Correspondence to Francesco Rubino.

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Soni, A., Shukla, A.P. & Rubino, F. Interventional Diabetology: The Evolution of Diabetes Care in the XXI Century. Curr Atheroscler Rep 14, 631–636 (2012). https://doi.org/10.1007/s11883-012-0289-1

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