This document summarizes research on the effects of bariatric surgery on metabolic parameters and type 2 diabetes. It shows that bariatric surgery leads to significant and sustained weight loss, improved glycemic control, reduced insulin resistance, normalization of lipid profiles and other metabolic markers. The surgery favors an anorectic hormone state that facilitates weight loss and metabolic improvements. Over time, bariatric surgery can result in remission or significant improvement of type 2 diabetes in many patients by addressing the underlying causes of insulin resistance and beta cell dysfunction.

2. %
Monteiro CA (unpublished data)- 2001

3. Morbid Obesity: long term treatment
Months
Bray 1999
Kg

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

6. 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

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

8. Homa-IR
Months

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

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

11. %
Geloneze B et al. Obes Res 2001 ; 9:763-9

12. 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

13. 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

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

15. Homa-Beta
Months

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

17. 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

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

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

20. Hunger Satiety
- 30 min + 30 min

21. 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

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.

24. Geloneze B, Arq Bras Endoc Metab abril 2006

25. 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

26. Intact
Stomach
Bypassed Intestinal Portion
Pancreas
Anastomoses
Gastro-jejunal

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

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

31. 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

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

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

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

35. 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

36. Bariatric surgery ⇒ Anti-diabetes surgery
Anti-dysmetabolic surgery

37. 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