Type 2 diabetes mellitus being one of the most prevalent diseases in the world has led to a variety of research using animal
models. This review focuses on various rat models to study the effect that surgical procedures have on type 2 diabetes mellitus
and obesity. Rat models can be classified as Obese Diabetic, Non-Obese Diabetic, Obese Non-Diabetic, and Non-Obese Non-Diabetic.
Here, we have discussed the particular characteristics of each rat so that it can provide the appropriate model to study different
pathological processes involve in type 2 Diabetes and obesity.
Disclaimer: authors certify no financial or commercial conflict of interest related to this publication. 相似文献
Remission of type 2 diabetes (T2D) is a desired outcome after bariatric surgery (BS). Even if this goal is not achieved, individuals who do not strictly fulfill remission criteria experience an overall improvement. The aim of this study was to evaluate the metabolic control status in patients considered as diabetes “non-remitters.”
Methods
A retrospective study of 125 patients (59.2 % women) with preoperative diagnosis of T2D who underwent BS in a single center (2006–2011) was conducted. We collected anthropometric and metabolic parameters before surgery and at 1-year follow-up. T2D remission was defined according to the 2009 consensus statement: glycosylated hemoglobin (HbA1c) <6 %, fasting glucose (FG) <100 mg/dLs, and absence of pharmacologic treatment. We evaluated metabolic status of non-remitters, according to the American Diabetes Association's (ADA) target recommendations: HbA1c <7 %, LDL-c <100 mg/dL, triglycerides <150 mg/dL, and HDL-c >40 (male) or >50 mg/dL (female). Statistics: analysis of variance.
Results
Baseline characteristics (mean ± SD): age 53.5?±?9.7 years, BMI 43.5?±?5.6 kg/m2, time since diagnosis of T2D 7.7?±?7.9 years, FG 162.0?±?56.3 mg/dL, HbA1c 7.7?±?1.6 %. ADA's target recommendations were present in 12 patients (9.6 %) preoperatively, and in 45 (36.0 %) at 1-year follow-up (p <0.001). Sixty-two (49.6 %) patients did not achieve diabetes remission; 26 (41.9 %) had now diet treatment, 30 (48.4 %) oral medications, and 6 (9.7 %) required insulin. Of the non-remitters, 57 (91.9 %) had HbA1c <7 % and 18 (40.0 %) achieved ADA's target recommendations. There were no differences between remitters and non-remitters in the number of individuals reaching ADA's combined metabolic control.
Conclusions
Although almost 50 % of the patients may not be classified as diabetes remitters, their significant improvement in metabolic control should be regarded as a success, according to most scientific societies' target recommendations. 相似文献
The prevalence of obesity in patients with type 1 diabetes mellitus (T1DM) has been increasing. Metabolic bariatric surgery (MBS) has proven to be effective in treating patients with T2DM. However, evidence for the benefit of the procedure for patients with T1DM is still limited, particularly in terms of glycemic control, demonstrating the need for a systematic review investigating this.
Method
A systematic review was performed in accordance with the PRISMA guidelines. Outcome measures such as weight loss, remission of comorbidities, pre- and post-intervention insulin requirements, and HbA1c levels were extracted.
Results
Thirty studies were included with a total of 706 patients (F = 524, M = 74, N/A = 60). The mean age was 40.01 years. The mean weight and body mass index (BMI) were 112.76 kg and 40.88 kg/m2 (24–58.9) respectively. The common procedure performed was RYGB (n = 497 (70.4%)), followed by SG (n = 131 (18.6%)). The mean decrease of insulin requirements was 92.3 IU/day (36.2–174) preoperatively to a mean of 35.8 IU/day (5–75) post-operatively. No significant trend was found for changes in HbA1c levels. The main side effects were episodes of hypoglycemia and diabetic ketoacidosis (DKA); there was no mortality. The mean %EWL was 74.57% (60–90.5%) at ≥ 6 follow-up months. Reductions in comorbidities such as hypertension and cardiovascular disease (CVD) were recorded in multiple studies.
Conclusion
Patients with obesity and T1DM can expect significant weight loss, potential resolution of comorbidities, and reduction of insulin requirements, but it does not usually result in improved glycemic control. Based on current review, best choice of bariatric surgery in such patients cannot yet be established.
Background Obesity is a major risk factor for the development of type 2 diabetes mellitus (T2DM). Surgery is the most effective treatment
for morbid obesity, and it has been shown to lead to dramatic improvement in type T2DM. However, data concerning obese Asian
patients have not been reported, and the mechanism of improving T2DM after bariatric surgery in this population remains speculative.
Methods From April 1997 to March 2006, 1,375 patients undergoing obesity surgery were recruited for our study of the effects of weight
loss surgery on type 2 diabetes mellitus (T2DM). Laparoscopic vertical banded gastric partition (LVBG) was performed in 552
patients (40.1%), laparoscopic gastric bypass in 660 patients (48.0%), and laparoscopic adjustable gastric banding (LAGB)
in 140 patients (10.2%). Another 23 patients (1.7%) received open or revision surgery. We evaluated the clinical data and
effect of obesity surgery on T2DM, impaired fasting glucose (IFG) and compared the changes with those with normal fasting
glucose.
Results Among all the patients, 166 (12.1%) had impaired fasting glucose (IFG) and 247 (18.0%) had T2DM. Patients with IFG or DM were
significantly older, more central obese, and they had higher insulin resistance and a higher HbA1C level than those with normal
fasting glucose. The mean total weight loss for the population was 28.6%, 29.1%, 28.5%, 23.8%, and 24.4% (at 1, 2, 3, 5, and
7 years after surgery). There was no increase of surgical risk in T2DM or IFG patients. One year after operation, fasting
plasma glucose returned to normal in 78.5% of T2DM patients and 94.7% of IFG patients. The HbA1C level returned to under 7.0
in 81.5% of T2DM and in 100% of IFG patients. Laparoscopic gastric bypass patients had a greater weight loss and a higher
rate of glucose normalization (93.1%) than the LVBG patients (85.3%) and LAGB patients (73.9%), but no difference in HbA1C
normalization.
Conclusions Obesity surgery resulted in significant and sustained weight loss with a cure rate of T2DM up to 80% in morbidly obese Asian
patients. Gastric bypass surgery had a better result in T2DM cure rate than LVBG and LAGB because of better weight reduction. 相似文献
Obesity and type 2 diabetes (T2D) represent major health concerns in the USA. Weight loss is the most important aspect in T2D management, as it reduces both morbidity and mortality. Available lifestyle, behavioral, and pharmacological strategies provide just mild to moderate weight loss. The greatest degree of T2D prevention or T2D amelioration in obese subjects has been reported in subjects who underwent bariatric surgery. In the current review, we will describe various types of bariatric surgery, related safety profiles, and their effect on T2D, as well as the potential mechanisms involved in the remission of T2D. Finally, we hereby examine whether bariatric surgery may be considered a treatment for T2D in pregnant women, children, adolescents and subjects at least 65 years old. 相似文献
It may be difficult to distinguish between adults with type 1 diabetes and type 2 diabetes by clinical assessment. In patients undergoing bariatric surgery, it is critical to correctly classify diabetes subtype to prevent adverse perioperative outcomes including diabetic ketoacidosis. This study aimed to determine whether testing for C-peptide and islet cell antibodies during preoperative evaluation for bariatric surgery could improve the classification of type 1 versus type 2 diabetes compared to clinical assessment alone.
Methods
This is a retrospective analysis of the Improving Diabetes through Lifestyle and Surgery trial, which randomized patients with clinically diagnosed type 2 diabetes and BMI 30–40 kg/m2 to medical weight loss or bariatric surgery; one participant was discovered to have type 1 diabetes after experiencing postoperative diabetic ketoacidosis. Using blood samples collected prior to study interventions, we measured islet cell antibodies and fasting/meal-stimulated C-peptide in all participants.
Results
The participant with type 1 diabetes was similar to the 11 participants with type 2 diabetes in age at diagnosis, adiposity, and glycemic control but had the lowest C-peptide levels. Among insulin-treated participants, fasting and stimulated C-peptide correlated strongly with the C-peptide area-under-the-curve on mixed meal tolerance testing (R = 0.86 and 0.88, respectively). Three participants, including the one with type 1 diabetes, were islet cell antibody positive.
Conclusions
Clinical characteristics did not correctly identify type 1 diabetes in this study. Preoperative C-peptide testing may improve diabetes classification in patients undergoing bariatric surgery; further research is needed to define the optimal C-peptide thresholds.
Type 1 diabetes mellitus (T1DM) has a rising global prevalence. Although it is vastly outnumbered by type 2 diabetes mellitus rates, it remains a persistent worldwide source of morbidity and mortality. Increasingly, its sufferers are afflicted by obesity and its complications. The objective of the study is to quantify the effects of bariatric surgery on T1DM by appraising the primary outcomes of glycosylated haemoglobin (HbA1c), insulin requirements and body mass index (BMI). Secondary outcomes included blood pressure, triglycerides and cholesterol biochemistry.
Methods
A systematic review of studies reporting pre-operative and post-operative outcomes in T1DM patients undergoing bariatric surgery was done. Data were meta-analysed using random effects modelling. Subgroup analysis and quality scoring were assessed.
Results
Bariatric surgery in obese T1DM patients is associated with a significant reduction in insulin requirement (?48.95 units, 95 % CI of ?56.27, ?41.62), insulin requirement per kilogramme (?0.391, 95 % CI of ?0.51, ?0.27), HbA1c (?0.933, 95 % CI of ?1.604, ?0.262) and BMI (?11.04 kg/m2, 95 % CI of ?13.49, ?8.59). Surgery is also associated with a statistically significant reduction in systolic and diastolic blood pressure and a significant beneficial rise in HDL. Heterogeneity in these results was high, and study quality was low overall.
Conclusions
Bariatric surgery in obese T1DM patients is associated with a significant improvement in insulin requirement and a significant though modest effect on HbA1c. These early results require further substantiation with future studies focusing on higher levels of evidence. This may offer a deeper understanding of diabetogenesis and can contribute to better selection and stratification of diabetic patients for metabolic surgery and future metabolic treatment strategies.
