%




    Monteiro CA (unpublished data)- 2001
Morbid Obesity: long term treatment
                                 Months




                                  Bray 199...
Leptin and RYGBP
Leptin (ng/ml)




                                                               Months

               ...
Bariatric Surgery
  Evolution of Metabolic Parameters

Modifiable              Partially Modifiable
Glycemic control      ...
* Glucose disposal
  (umol/L/min-1/kg-1)



                    Normal




                                               ...
Homa-IR




          Months
Insulin
(mU/mL)




                                               months


          Geloneze et al – Obes Surg 2001; 11:...
HAS
Baseline                   71%
After surgery              35%**



                ** Better control with less medicat...
%




    Geloneze B et al. Obes Res 2001 ; 9:763-9
Insulin Resistance
                            Long term results (Kitt)
                                 Geloneze et al – ...
Insulin sensitivity and Bariatric Surgery in
                    Diabetes

             Glicemia (mmol/L)       Kitt (mg%/...
Weight                 Reversion of
Loss                    Metabolic
                        Syndrome

         Improveme...
Homa-Beta




            Months
Insulin Secretion – IVGTT
                   IntraVenousGlucoseToleranceTest


                        First
             ...
Recovery of First Phase Insulin
                   Primeira Fase de Secreção
                  pós Secretion after RYGBP
 ...
Valverde I et al – Obesity Surgery 15:387-397,2005.
UNICAMP 2003

ug/mL                          umol/min.FFM

        * p=0.01
                   * p=0.006




             ...
Hunger   Satiety




- 30 min              + 30 min
Ghrelin and Bariatric Surgery (RYGBP)
Ghrelin (pg/ml)
                                                   * p < 0.0001



 ...
Gut hormone profiles following bariatric surgery favor an anorectic state,
facilitate weight loss, and improve metabolic p...
Geloneze B, Arq Bras Endoc Metab abril 2006
Bariatric procedures and Mechanisms of Action

              R
R
                          Restrictive (R)   Disabsortive ...
Intact
                                    Stomach
Bypassed Intestinal Portion
                              Pancreas

   ...
A1C (%)




                                      ** p < 0.05




          * p < 0.01

                       Geloneze et...
Porcentagem de reducao




                                                        *

                             *




 ...
Resolution(R) versus non-Resolution (NR)
             T2DM after RYGBP
                        resolution (n=18)     non-r...
Treatment based on Consequences = TODAY

    Prevention                             Preservation
                         ...
Rationale for Treatment
    Prevention                             Preservation
                                         B...
Treatment based on Causes = TOMORROW

    Prevention                             Preservation
                            ...
Treatment of T2DM and complications

                       Beta cell dysfunction
                                        ...
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
M...
Obesidad: ¿Enfermedad Quirurgica? Efectos Metabólicos de la Cirugía Bariátrica en Diabetes y Obesidad
Obesidad: ¿Enfermedad Quirurgica? Efectos Metabólicos de la Cirugía Bariátrica en Diabetes y Obesidad
Obesidad: ¿Enfermedad Quirurgica? Efectos Metabólicos de la Cirugía Bariátrica en Diabetes y Obesidad
Obesidad: ¿Enfermedad Quirurgica? Efectos Metabólicos de la Cirugía Bariátrica en Diabetes y Obesidad
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

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

  1. 1. % Monteiro CA (unpublished data)- 2001
  2. 2. Morbid Obesity: long term treatment Months Bray 1999 Kg
  3. 3. Leptin and RYGBP Leptin (ng/ml) Months Geloneze et al – Obes Surg 2001; 11:693-8
  4. 4. 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
  5. 5. * Glucose disposal (umol/L/min-1/kg-1) Normal Months * Euglycemic Hyperinsulinemic Clamp Muscelli, Pareja, Ferrannini et al, Am J Med 2005
  6. 6. Homa-IR Months
  7. 7. Insulin (mU/mL) months Geloneze et al – Obes Surg 2001; 11:693-8
  8. 8. HAS Baseline 71% After surgery 35%** ** Better control with less medications UNICAMP/2005
  9. 9. % Geloneze B et al. Obes Res 2001 ; 9:763-9
  10. 10. 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
  11. 11. 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
  12. 12. Weight Reversion of Loss Metabolic Syndrome Improvement on Insulin Sensitivity UNICAMP 2005
  13. 13. Homa-Beta Months
  14. 14. Insulin Secretion – IVGTT IntraVenousGlucoseToleranceTest First Phase Insulina (µU/mL) Second Phase Time (min) Lebovitz et al – Diabetes Reviews 7:139, 1999
  15. 15. 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
  16. 16. Valverde I et al – Obesity Surgery 15:387-397,2005.
  17. 17. UNICAMP 2003 ug/mL umol/min.FFM * p=0.01 * p=0.006 * p<0,0001
  18. 18. Hunger Satiety - 30 min + 30 min
  19. 19. 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
  20. 20. 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.
  21. 21. Geloneze B, Arq Bras Endoc Metab abril 2006
  22. 22. 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
  23. 23. Intact Stomach Bypassed Intestinal Portion Pancreas Anastomoses Gastro-jejunal
  24. 24. A1C (%) ** p < 0.05 * p < 0.01 Geloneze et al – Obes Surg Aug 2009
  25. 25. Porcentagem de reducao * * Geloneze et al – Obes Surg Aug 2009 *
  26. 26. 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
  27. 27. Treatment based on Consequences = TODAY Prevention Preservation Beta cell function Hyperglicemia (Microvascular T2DM Complications) Reduction Aterosclerosis (Macrovascular complications) of Adiposity
  28. 28. Rationale for Treatment Prevention Preservation Beta cell function Hyperglicemia (Microvascular DM 2 Complications) Reduction Aterosclerosis (Macrovascular complications) of Adiposity
  29. 29. Treatment based on Causes = TOMORROW Prevention Preservation Beta cell function Hyperglicemia (Microvascular DM 2 Complications) Reduction Aterosclerosis (Macrovascular complications) of Adiposity
  30. 30. 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
  31. 31. Bariatric surgery ⇒ Anti-diabetes surgery Anti-dysmetabolic surgery
  32. 32. 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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