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Who will benefit from bariatric surgery for diabetes? A protocol for an observational cohort study
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  • Published on:
    Authors' reply to Professor Adami
    • Tricia M Tan, Consultant in Diabetes, Endocrinology and Metabolic Medicine Imperial College London

    We would like to thank Professor Adami for his comments regarding the possible differing pathogenic processes driving T2DM at low versus higher BMIs and the importance of accounting for this when assessing the predictive capacity of a co-variate such as diabetes duration. We certainly agree that T2DM is a heterogenous disease [1]. However, Taylor and Holman describe a convincing body of evidence that questions whether those who are non-obese have a greater defect in β cell function and insulin deficiency compared to those with higher BMI [2], suggesting that the relationship of BMI to β cell reserve may not be simple.

    We agree that it would indeed be interesting to understand if there is an interaction between T2DM duration and BMI. To investigate the hypothesis, therefore, would require a study that recruited people with diabetes and a wide range of BMI (e.g. ≥25 kg/m2). In the UK, commissioning of bariatric surgery is restricted to people with a BMI ≥35 kg/m2 in most cases, and always ≥30 kg/m2. Hence, unfortunately, our study will not test Professor Adami’s most interesting hypothesis.

    1. Ahlqvist, E., et al., Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. The Lancet Diabetes & Endocrinology, 2018. 6(5): p. 361-369.
    2. Taylor, R. and Rury R. Holman, Normal weight individuals who develop Type 2 diabetes: the personal fat threshold. Clinical Science, 2014. 128(7): p. 40...

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    Conflict of Interest:
    None declared.
  • Published on:
    diabetes remission after bariatric surgery
    • Gian F adami, professor of clinical nutrition university of Genova

    Kenkre et al. designed a multicenter investigation in order to prospectively evaluating preoperative parameters that can predict a stable diabetes remission in obese patients with type 2 diabetes (T2DM) undergoing bariatric/metabolic surgery (1). Candidate predictors , ave been detected from previous retrospective studies and their predicting efficacy will be tested in a large and disseminated cohort of operated patients. Multivariate logistic regression model will be then used to assess the value in terms of prediction of diabetes remission of these preoperative parameters. In severely obese patients with T2DM biliopancreatic diversion (BPD) causes a steadily long term serum glucose level normalization in the majority of the cases. In patients with a preoperative T2DM duration of approximately one year, the diabetes remission was observed in nearly all cases, while in those with a T2DM duration of more than five years the remission rate was lower than 75% (2). This suggest a major role of T2DM duration as a predictor of insulin secretion reserve. In severely obese operated subjects, most likely for a still adequate beta-cell reserve (3), a rapid recovery of insulin secretion after BPD subjects develops (4), thus determining a stable improvement in metabolic pattern. A long T2DM duration entails a severe reduction of functioning pancreatic B cells and a reduced beta bell mass , insulin secretion and a lower postoperative T2DM remission rate. At a lower obesity degree, a p...

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    Conflict of Interest:
    None declared.
  • Published on:
    diabetes remission after bariatric surgery
    • Gian F adami, professor of clinical nutrition university of Genova

    Kenkre et al. designed a multicenter investigation in order to prospectively evaluating preoperative parameters that can predict a stable diabetes remission in obese patients with type 2 diabetes (T2DM) undergoing bariatric/metabolic surgery (1). Candidate predictors , ave been detected from previous retrospective studies and their predicting efficacy will be tested in a large and disseminated cohort of operated patients. Multivariate logistic regression model will be then used to assess the value in terms of prediction of diabetes remission of these preoperative parameters. In severely obese patients with T2DM biliopancreatic diversion (BPD) causes a steadily long term serum glucose level normalization in the majority of the cases. In patients with a preoperative T2DM duration of approximately one year, the diabetes remission was observed in nearly all cases, while in those with a T2DM duration of more than five years the remission rate was lower than 75% (2). This suggest a major role of T2DM duration as a predictor of insulin secretion reserve. In severely obese operated subjects, most likely for a still adequate beta-cell reserve (3), a rapid recovery of insulin secretion after BPD subjects develops (4), thus determining a stable improvement in metabolic pattern. A long T2DM duration entails a severe reduction of functioning pancreatic B cells and a reduced beta bell mass , insulin secretion and a lower postoperative T2DM remission rate. At a lower obesity degree, a p...

    Show More
    Conflict of Interest:
    None declared.