Obesidad: ¿Enfermedad Quirurgica? Efectos Metabólicos de la Cirugía Bariátrica en Diabetes y Obesidad

% Monteiro CA (unpublished data)- 2001

Morbid Obesity: long term treatment Months Bray 1999 Kg

Leptin and RYGBP Leptin (ng/ml) Months Geloneze et al – Obes Surg 2001; 11:693-8

Bariatric Surgery Evolution of Metabolic Parameters Modifiable Partially Modifiable Glycemic control Total cholesterol HDL-Chol LDL-Chol Triglycerides Uric acid Gamma-GT Fibrinogen Leucocitoses Insulin NASH Geloneze B et al. Obes Res 2001 ; 9:763-9

* Glucose disposal (umol/L/min-1/kg-1) Normal Months * Euglycemic Hyperinsulinemic Clamp Muscelli, Pareja, Ferrannini et al, Am J Med 2005

Homa-IR Months

Insulin (mU/mL) months Geloneze et al – Obes Surg 2001; 11:693-8

HAS Baseline 71% After surgery 35%** ** Better control with less medications UNICAMP/2005

% Geloneze B et al. Obes Res 2001 ; 9:763-9

Insulin Resistance Long term results (Kitt) Geloneze et al – Diabetes (ADA – San Diego) 2005 Insulin resistance %/min ns BMI 52 46 42 39 34 33

Insulin sensitivity and Bariatric Surgery in Diabetes Glicemia (mmol/L) Kitt (mg%/min) HbA1c (%) IMC 54,1 40,6 35,5 IMC 54,1 40,6 35,5 Geloneze B et al. Obes Res 2001 ; 9:763-9

Weight Reversion of Loss Metabolic Syndrome Improvement on Insulin Sensitivity UNICAMP 2005

Homa-Beta Months

Insulin Secretion – IVGTT IntraVenousGlucoseToleranceTest First Phase Insulina (µU/mL) Second Phase Time (min) Lebovitz et al – Diabetes Reviews 7:139, 1999

Recovery of First Phase Insulin Primeira Fase de Secreção pós Secretion after RYGBP Cirurgia de Gastroplastia Insulin (µU/mL) Primeira Fase First Second Phase Phase Time (min) Polyzogopolou EV et al – Diabetes 2003; 52:1098

Valverde I et al – Obesity Surgery 15:387-397,2005.

UNICAMP 2003 ug/mL umol/min.FFM * p=0.01 * p=0.006 * p<0,0001

Hunger Satiety - 30 min + 30 min

Ghrelin and Bariatric Surgery (RYGBP) Ghrelin (pg/ml) * p < 0.0001 NS * p < 0.001 * p < 0.001 Geloneze B et al – Obesity Surgery 2003; 13:17-22

Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg 2006;243:108 Adapted from le Roux CW, Aylwin SJ, Batterham RL, et al.

Geloneze B, Arq Bras Endoc Metab abril 2006

Bariatric procedures and Mechanisms of Action R R Restrictive (R) Disabsortive (D) Satiety (S) Incretin (IN) R R R S S S D D IN

Intact Stomach Bypassed Intestinal Portion Pancreas Anastomoses Gastro-jejunal

A1C (%) ** p < 0.05 * p < 0.01 Geloneze et al – Obes Surg Aug 2009

Porcentagem de reducao * * Geloneze et al – Obes Surg Aug 2009 *

Resolution(R) versus non-Resolution (NR) T2DM after RYGBP resolution (n=18) non-resolution (n=18) Time of diagnosis (y) 10,1 (±7,4) 13,6 (±6,3) BMI baseline (kg/m²) 46,9 (±4,5) 46 (±6,7) BMI 2 y after (kg/m²) 33 (±4,4) 33,2 (±8,7) Fat mass (%) 36,9 (±6,1) 34 (±10,7) Waist/Hip Ratio 0,85 (±0,04) 0,90 (±0,06) Age (y) 55,7 (±5,7) 54,9 (±6,9) C-peptide 6,19 (±2,29) 6,38 (±1) usCRP 0.14 0.24 p<0.05 Homa-IR 1.02 (±0,28) 2.38 (±1,5) p<0.01 Adiponectin 9.7 (4.3) 15.8 (6.2) p<0.05 Geloneze, Pareja et al. ADA 2008

Treatment based on Consequences = TODAY Prevention Preservation Beta cell function Hyperglicemia (Microvascular T2DM Complications) Reduction Aterosclerosis (Macrovascular complications) of Adiposity

Rationale for Treatment Prevention Preservation Beta cell function Hyperglicemia (Microvascular DM 2 Complications) Reduction Aterosclerosis (Macrovascular complications) of Adiposity

Treatment based on Causes = TOMORROW Prevention Preservation Beta cell function Hyperglicemia (Microvascular DM 2 Complications) Reduction Aterosclerosis (Macrovascular complications) of Adiposity

Treatment of T2DM and complications Beta cell dysfunction Oral drugs, Exenatide, Insulin, Bariatric surgery Cardiac problems Hyperglicemia Renal failure Complications Visual impairment Drugs, Drugs, Optical surgery Coronary bypass Insulin resistance Dyalisis Angioplasty Transplantation Bariatric surgery? Oral drugs, weight loss, exercise Bariatric surgery

Bariatric surgery ⇒ Anti-diabetes surgery Anti-dysmetabolic surgery

Cirurgia Metab Elinton Chaim José C Pareja Cardio Metabol J Roberto Souza Otavio R Coelho Wilson Nadruz Biol Molecular Mario A Saad Mirian Ueno Sinal.Celular Eliana Araujo Licio Velloso Proteomica Rodrigo Catharino

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Obesidad: ¿Enfermedad Quirurgica? Efectos Metabólicos de la Cirugía Bariátrica en Diabetes y Obesidad

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Obesidad: ¿Enfermedad Quirurgica? Efectos Metabólicos de la Cirugía Bariátrica en Diabetes y Obesidad — Presentation Transcript