Impact of Laparoscopic Sleeve Gastrectomy on Obese Type 2 Diabetic Patients and Role of Gut Hormones Peptide Tyrosine Tyrosine and Glucagon Like Peptide 1on Remission of Diabetes

Main Article Content

Heba H. Zayed
Karim Sabry
Yasser M Abdelraouf
Wessam M. Salah
Ingy Abdel Wahab
Mabrouk R EL- Sheikh

Abstract

Our Study Aimed: To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on obese T2DM patients, its effect in remission of diabetes and role of gastrointestinal Glucagon like peptide 1(GLP1) and Peptide tyrosine tyrosine (PYY) hormones. Metabolic surgery should be recommended as an option in type 2 diabetic patients (T2DM) with body mass index (BMI) ≥40 Kg/m2, in patients who have BMI ≥35 Kg/m2 and in selected patients with BMI < 35 Kg/m2, if not achieving diabetes control with maximum tolerated anti-hyperglycemic treatment.

Methods: 30 T2DM patients with BMI ≥ 40 kg/m2 underwent laparoscopic sleeve gastrectomy after full clinical evaluation, routine blood tests, glucagon like peptide 1, Peptide tyrosine tyrosine (fasting, 0.5-hour post-mixed meal test (MMT) serum levels) and upper GIT endoscopy. Follow-up visits were at 3, 6 and 9 months postoperatively to evaluate body weight, BMI and glycated hemoglobin (HbA1C) and at 18th month for confirmation of diabetes remission. Gut hormones were measured at 15 days and 9 months postoperatively.

Results: (53.3%) of patients had partial remission of T2DM according to HbA1C remission criteria. There was significant increase in fasting and post-MMT levels of peptide tyrosine tyrosine, glucagon like peptide 1 postoperatively. The only independent predictors for remission of T2DM were the baseline serum low density lipoprotein cholesterol (LDL-Ch), duration of diabetes, preoperative post MMT Peptide tyrosine tyrosine plasma level, serum thyroid stimulating hormone (TSH) and age.

Conclusions: laparoscopic sleeve gastrectomy can induce partial remission of diabetes in younger patients who had shorter duration of diabetes, higher level of preoperative post-MMT peptide tyrosine tyrosine, lower levels of preoperative serum LDL-Ch and thyroid stimulating hormone.

Keywords:
Laparoscopic sleeve gastrectomy, glucagon like peptide 1, peptide tyrosine tyrosine, Mixed Meal Test (MMT).

Article Details

How to Cite
Zayed, H. H., Sabry, K., Abdelraouf, Y. M., Salah, W. M., Wahab, I. A., & Sheikh, M. R. E.-. (2020). Impact of Laparoscopic Sleeve Gastrectomy on Obese Type 2 Diabetic Patients and Role of Gut Hormones Peptide Tyrosine Tyrosine and Glucagon Like Peptide 1on Remission of Diabetes. Journal of Advances in Medicine and Medical Research, 32(11), 80-91. https://doi.org/10.9734/jammr/2020/v32i1130536
Section
Original Research Article

References

Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, Malanda B. IDF Diabetes atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045.DIABETES Res Clin Pract. 2018;138:271-281.

DOI: 10.1016/j.diabres.2018.02.023

Zaccardi F, Webb DR, Yates T, Davies MJ. Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective. Postgrad Med J. 2016;92(1084):63-69.

DOI: 10.1136/postgradmedj-2015-133281

World Health Organization obesity and overweight fact sheet; 2016.

Available:https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight Accessed at 5/5/2019 at 6 p.m

Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: A comprehensive review. Circulation. 2016;133(2):187-225.

DOI: 10.1161/CIRCULATIONAHA.115.018585

(English WJ, Williams DB. Metabolic and bariatric surgery: A viable treatment option for obesity. Prog Cardiovasc Dis 2018;61(2):253-269.

DOI: 10.1016/j.pcad.2018.06.003

Ramos-Levi A, Sanchez-Pernaute A, Matia P, Cabrerizo L, Barabash A, Hernandez C, Calle-Pascual A, Torres A, Rubio M. Diagnosis of diabetes remission after bariatic surgery may be jeopardized by remission criteria and previous hypoglycemic treatment. Obes Surg. 2013; 23(10):1520-1526.

DOI: 10.1007/s11695-013-0995-y

Abd El Raouf Y, Alghazaly G, Elsharawy T. The relationship between serum thyroid stimulating hormone (TSH) level within normal reference range and metabolic syndrome.Life Sci J 2015;12(10):105-112.

Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes-5-year outcomes. N Engl J Med. 2017;376(7):641-651.

DOI: 10.1056/NEJMoa1600869

Kashyap SR, Bhatt DL, Wolski K, et al. Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes care. 2013; 36(8):2175-2182.

DOI: 10.2337/dc12-1596

Biro SM, Olson DL, Garren MJ, Gould JC. Diabetes remission and glycemic response to pre-bariatric surgery diet. J SURG RES 2013;185(1):1-5.

Available:https://doi: 10.1016/j.jss

Wang GF, Yan YX, Xu N, et al. Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis. Obes surg. 2015;25(2):199-208.

Available:https://10.1007/s11695-014-1391-y

Golomb I, David MB, Glass A, Kolitz T, Keidar A. Long-term metabolic effects of laparoscopic sleeve gastrectomy. JAMA surg. 2015;150(11):1051-1057.

Available:https://doi: 10.1001/jamasurg

Schauer PR, Bhatt DL, Kirwan JP et al. Bariatric surgery versus intensive medical therapy for diabetes-3-year outcomes. N Engl J Med. 2014;370(21): 2002-2013.

Available:https://DOI:10.1056/NEJMoa1401329

Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, Bucher HC, Nordmann AJ. Bariatric surgery versus non-surgical treatment for obesity: A systematic review and meta-analysis of randomised controlled trials. Bmj. 2013;347:f5934.

Available:https://DOI:10.1136/bmj

Martinez-Ortiz CA, Saldívar-Frías JB, Rodriguez-Gonzalez AA, Cuevas-Marban CY. Evolution of type 2 diabetes mellitus in patients undergoing vertical sleeve gastrectomy or Roux-en-Y gastric bypass. Appl Food Sci J. 2017;2(1):25-33.

Available:http://creativecommons.org/licenses/by-nc/4.0/

Capoccia D, Coccia F, Guarisco G, Testa M, Rendina R, Abbatini F, Silecchia G, Leonetti F. Long-term metabolic effects of laparoscopic sleeve gastrectomy. Obes Surg. 2018;28(8):2289-2296.

Available:http://doi:10.1007/s11695-018-3153-8.

Panunzi S, Carlsson L, De Gaetano A, Peltonen M, Rice T, Sjöström L, Mingrone G, Dixon JB. Determinants of diabetes remission and glycemic control after bariatric surgery. Diabetes Care. 2016; 39(1):166-172.

Available:http:// doi: 10.2337/dc15-0575.

Korner J, Inabnet W, Conwell IM, Taveras C, Daud A, Olivero‐Rivera L, Restuccia NL, Bessler M. Differential effects of gastric bypass and banding on circulating gut hormone and leptin levels. Obesity 2006;14(9):1553-1561.

Available:http:// doi: 10.1038/oby.2006.179

Peterli R, Steinert R, Wölnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic roux-en-Y gastric bypass and sleeve gastrectomy: A randomized, prospective trial. Obes Surg. 2012;22(5): 740-748.

Available:http:// doi: 10.1007/s11695-012-0622-3

Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: A prospective, double blind study. Ann Surg 2008;247(3):401-407.

Available:http://doi:10.1097/SLA.0b013e318156f012

Yousseif A, Emmanuel J, Karra E, et al. Differential effects of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on appetite, circulating acyl-ghrelin, peptide YY3-36 and active GLP-1 levels in non-diabetic humans. Obes surg 2014; 24(2):241-52.

Available:http://doi:10.1007/s11695-013-1066-0.

Nannipieri M, Baldi S, Mari A, et al. Roux-en-Y gastric bypass and sleeve gastrectomy: Mechanisms of diabetes remission and role of gut hormones. J Clin Endocrinol Metab. 2013;98(11):4391- 4399.

Available:http://doi:10.1210/jc.2013-2538

Ejarque M, Guerrero-Pérez F. de la Morena, N et al. Role of adipose tissue GLP-1R expression in metabolic improvement after bariatric surgery in patients with type 2 diabetes. Sci Rep. 2019;9:6274.

Available:http://DOI:10.1038/s41598-019-42770-1

Nausheen S, Shah IH, Pezeshki A, Sigalet DL, Chelikani PK. Effects of sleeve gastrectomy and ileal transposition, alone and in combination, on food intake, body weight, gut hormones, and glucose metabolism in rats. Am J Physiol Endocrinol Metab. 2013;305(4):E507- E18.

Available:http://DOI:10.1152/ajpendo.00130.2013

Korner J, Bessler M, Inabnet W, Taveras C, Holst JJ. Exaggerated glucagon-like peptide-1 and blunted glucose-dependent insulinotropic peptide secretion are associated with Roux-en-Y gastric bypass but not adjustable gastric banding. SurgObesRelat Dis. 2007;3(6):597-601.

Available:http://DOI:10.1016/j.soard.2007.08.004

Jiménez A, Mari A, Casamitjana R, Lacy A, Ferrannini E, Vidal J. GLP-1 and glucose tolerance after sleeve gastrectomy in morbidly obese subjects with type 2 diabetes. Diabetes. 2014;63(10):3372-3377.

Available:http://DOI: 10.2337/db14-0357

Milone M, Di Minno MND, Leongito M et al (2013) Bariatric surgery and diabetes remission: sleeve gastrectomy or mini-gastric bypass? World J Gastroentero 19(39):6590–6597.

DOI: 10.3748/wjg.v19.i39.6590.

Torquati A, Lutfi R, Abumrad N, Richards WO. Is Roux-en-Y gastric bypass surgery the most effective treatment for type 2 diabetes mellitus in morbidly obese patients? J Gastrointest Surg. 2005;9(8): 1112-1118.

Available:http://DOI:10.1016/j.gassur.2005.07.016

Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Annsurg. 2003;238(4): 467-472.

Available:http://DOI:10.1097/01.sla.0000089851.41115.1b

Sugerman HJ, Wolfe LG, Sica DA, Clore JN. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003; 237(6):751-759.

Available:http://DOI:10.1097/01.SLA.0000071560.76194.11

Casajoana A, Pujol J, Garcia A, Elvira J, Virgili N, de Oca FJ, et al. Predictive value of gut peptides in T2D remission: Randomized controlled trial comparing metabolic gastric bypass, sleeve gastrectomy and greater curvature plication. Obes Surg. 2017;27(9):2235-2245.

Available:http://DOI:10.1007/s11695-017-2669-7.

Pham MH, Ballegaard C, de Knegt MC, Sigvardsen PE, Sørgaard MH, Fuchs A, Kofoed KF. Normal values of aortic dimensions assessed by multidetector computed tomography in the copenhagen general population study. European Heart Journal-Cardiovascular Imaging. 2019; 20(8):939-948.

Noronha Neto CC, Maia SS, Katz L, Coutinho IC, Souza AR, Amorim MM. Clonidine versus captopril