Skip to main content
Erschienen in: Obesity Surgery 9/2008

01.09.2008 | Research Article

Improvement of Insulin Resistance After Obesity Surgery: A Comparison of Gastric Banding and Bypass Procedures

verfasst von: Wei-Jei Lee, Yi-Chih Lee, Kong-Han Ser, Jung-Chien Chen, Shu Chung Chen

Erschienen in: Obesity Surgery | Ausgabe 9/2008

Einloggen, um Zugang zu erhalten

Abstract

Background

Obesity is a major risk factor for the development of type 2 diabetes mellitus (T2DM). Insulin resistance (IR) is considered the pathologic link between T2DM and obesity. The mechanism in improving T2DM after bariatric surgery remains speculative. This trial assessed the effect of duodenal jejunal exclusion on the resolution of IR in gastric banding and gastric bypass procedures.

Methods

660 patients with complete biochemical and clinical data at baseline and at 3 years were selected for analysis. There were 197 males and 463 females. The mean age was 31.5 years (18–64) and mean BMI was 41.4 (32–77). There were 544 patients who received laparoscopic gastric bypass, and 116 patients received laparoscopic gastric banding. IR was measured by homeostatic model assessment (HOMA) index (HI), that can be calculated as HI = plasma glucose (mmol/l) × insulin (UI/ml)/22.5. HI was measured before surgery and 1, 3, 6, 12, 24, and 36 months after surgery.

Results

Of the 660 individuals, 517 (78.4%) had IR. The mean HI was 7.62 ± 13.13. The HI was correlated with BMI, waist circumference, insulin resistance, hyperlipidemia, inflammatory indicators, and abnormal liver enzymes. Before surgery, the HI was 7.92 ± 14.18 for the bypass group and 6.27 ± 6.47 for the banding group. After surgery, the HI began to lower in both groups, and this reduction was maintained during follow-up. At 36 months after surgery, mean percentage of excess weight loss (%EWL) was 70.5% for the bypass group and 41.9% for the banding group. The HI was 1.00 ± 0.79 for bypass and 1.51 ± 1.25 for banding. The bypass patients had a better and faster weight reduction, but the HI was similar between the two groups at the same weight reduction percentage.

Conclusion

IR is common in morbidly obese patients. Both gastric banding and gastric bypass are effective for the reverse of IR in these patients. It seems that the effect is related to the absolute weight loss rather than different surgical procedures. There is no duodenal jejunal exclusion effect on IR resolution was observed in this study.
Literatur
1.
Zurück zum Zitat Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–9.PubMedCrossRef Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–9.PubMedCrossRef
2.
Zurück zum Zitat Allison DB, Fontaine KR, Manson JE, et al. Annual deaths attributable to obesity in the United States. JAMA. 1999;284:1530–8.CrossRef Allison DB, Fontaine KR, Manson JE, et al. Annual deaths attributable to obesity in the United States. JAMA. 1999;284:1530–8.CrossRef
3.
Zurück zum Zitat Mokdad AH, Marks JS, Stroup DR, et al. Actual causes of death in the United States. 2000 JAMA. 2004;291:1238–45.CrossRef Mokdad AH, Marks JS, Stroup DR, et al. Actual causes of death in the United States. 2000 JAMA. 2004;291:1238–45.CrossRef
4.
Zurück zum Zitat Jallut D, Golay A, Munger R, et al. Impaired glucose tolerance and diabetes in obesity: a 6-year follow-up study of glucose metabolism. Metabolism. 1990;39:1068–75.PubMedCrossRef Jallut D, Golay A, Munger R, et al. Impaired glucose tolerance and diabetes in obesity: a 6-year follow-up study of glucose metabolism. Metabolism. 1990;39:1068–75.PubMedCrossRef
5.
Zurück zum Zitat Panzram G. Mortality and survival in type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1998;30:123–31.CrossRef Panzram G. Mortality and survival in type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1998;30:123–31.CrossRef
6.
Zurück zum Zitat National Task Force on the Prevention and Treatment of Obesity. Overweight, obesity, and health risk. Arch Int Med. 2000;160:898–904.CrossRef National Task Force on the Prevention and Treatment of Obesity. Overweight, obesity, and health risk. Arch Int Med. 2000;160:898–904.CrossRef
7.
Zurück zum Zitat Matthews DR, Hosker JP, Rudensky AS, et al. Homeostasis model assessment: insulin resistance and B-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia. 1985;28:412–9.PubMedCrossRef Matthews DR, Hosker JP, Rudensky AS, et al. Homeostasis model assessment: insulin resistance and B-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia. 1985;28:412–9.PubMedCrossRef
8.
Zurück zum Zitat Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation provides to be the most effective therapy for adult onset diabetes mellitus. Ann Surg. 1995;222:339–52.PubMedCrossRef Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation provides to be the most effective therapy for adult onset diabetes mellitus. Ann Surg. 1995;222:339–52.PubMedCrossRef
9.
Zurück zum Zitat Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetes subjects 1 year after laparoscopic adjustable gastric banding. Diabetes C. 2002;25:358–63.CrossRef Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetes subjects 1 year after laparoscopic adjustable gastric banding. Diabetes C. 2002;25:358–63.CrossRef
10.
Zurück zum Zitat Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef
11.
Zurück zum Zitat Gumbs AA, Modlin IM, Ballantyne GH. Changed in insulin resistance following bariatric surgery: role of caloric restriction and weight loss. Obes Surg. 2005;15:462–73.PubMedCrossRef Gumbs AA, Modlin IM, Ballantyne GH. Changed in insulin resistance following bariatric surgery: role of caloric restriction and weight loss. Obes Surg. 2005;15:462–73.PubMedCrossRef
12.
Zurück zum Zitat Hickey MS, Pories WJ, MacDonald KG, et al. A new paradigm for type 2 diabetes mellitus. could it be a disease of the foregut? Ann Surg. 1998;227:637–44.PubMedCrossRef Hickey MS, Pories WJ, MacDonald KG, et al. A new paradigm for type 2 diabetes mellitus. could it be a disease of the foregut? Ann Surg. 1998;227:637–44.PubMedCrossRef
13.
Zurück zum Zitat Greenway SE, Greenway EL, Klevin S. Effected of obesity surgery on non-insulin-dependent diabetes mellitus. Arch Surg. 2002;137:1109–17.PubMedCrossRef Greenway SE, Greenway EL, Klevin S. Effected of obesity surgery on non-insulin-dependent diabetes mellitus. Arch Surg. 2002;137:1109–17.PubMedCrossRef
14.
Zurück zum Zitat Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004;240:236–42.PubMedCrossRef Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004;240:236–42.PubMedCrossRef
15.
Zurück zum Zitat Rubino F, Marescaux J. Effects of duodenal–jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239:1–11.PubMedCrossRef Rubino F, Marescaux J. Effects of duodenal–jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239:1–11.PubMedCrossRef
16.
17.
Zurück zum Zitat Wang W, Wei PL, Lee YC, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15:648–54.PubMedCrossRef Wang W, Wei PL, Lee YC, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15:648–54.PubMedCrossRef
18.
Zurück zum Zitat Lee WJ, Wang W, Yu PJ, et al. Gastrointestinal quality of life following laparoscopic adjustable gastric banding in Asia. Obes Surg. 2006;16:586–91.PubMedCrossRef Lee WJ, Wang W, Yu PJ, et al. Gastrointestinal quality of life following laparoscopic adjustable gastric banding in Asia. Obes Surg. 2006;16:586–91.PubMedCrossRef
19.
Zurück zum Zitat Doar JW, Wilde CE, Thompson ME, et al. Influence of treatment with diet alone on oral glucose-tolerance test and plasma sugar and insulin levels in patients with maturity onset diabetes mellitus. Lancet. 1975;1(7919):1263–6.PubMedCrossRef Doar JW, Wilde CE, Thompson ME, et al. Influence of treatment with diet alone on oral glucose-tolerance test and plasma sugar and insulin levels in patients with maturity onset diabetes mellitus. Lancet. 1975;1(7919):1263–6.PubMedCrossRef
20.
Zurück zum Zitat Kelly DE, Wing R, Buonocore C, et al. Relative effect soft calorie restriction and weight loss in non-insulin-dependent diabetes mellitus. J Clin Endocrinol Metab. 1993;77:1287–93.CrossRef Kelly DE, Wing R, Buonocore C, et al. Relative effect soft calorie restriction and weight loss in non-insulin-dependent diabetes mellitus. J Clin Endocrinol Metab. 1993;77:1287–93.CrossRef
21.
Zurück zum Zitat Ash S, Reeves MM, Yeo S, et al. Effect of intensive dietetic interventions on weight and glycemic control in overweight men with type II diabetes: a randomized trial. Int J Obes. 2003;27:797–802.CrossRef Ash S, Reeves MM, Yeo S, et al. Effect of intensive dietetic interventions on weight and glycemic control in overweight men with type II diabetes: a randomized trial. Int J Obes. 2003;27:797–802.CrossRef
22.
Zurück zum Zitat Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. NEJM. 2001;344:1343–50.PubMedCrossRef Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. NEJM. 2001;344:1343–50.PubMedCrossRef
23.
Zurück zum Zitat Harder H, Dinesen B, Astrup A. The effect of rapid weight loss on lipid profile and glycemic control in obese type 2 diabetic patients. Int J Obes. 2004;28:180–2.CrossRef Harder H, Dinesen B, Astrup A. The effect of rapid weight loss on lipid profile and glycemic control in obese type 2 diabetic patients. Int J Obes. 2004;28:180–2.CrossRef
24.
Zurück zum Zitat Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242:20–8.PubMedCrossRef Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242:20–8.PubMedCrossRef
25.
Zurück zum Zitat Flum DR, Salem L, Elrod JAB, et al. Early mortality among medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294:1903–8.PubMedCrossRef Flum DR, Salem L, Elrod JAB, et al. Early mortality among medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294:1903–8.PubMedCrossRef
26.
Zurück zum Zitat Lee WJ, Chen HH, Wang W, et al. Metabolic syndrome in obese patients referred for weight reduction surgery in Taiwan. J Formos Med Assoc. 2003;102:459–64.PubMed Lee WJ, Chen HH, Wang W, et al. Metabolic syndrome in obese patients referred for weight reduction surgery in Taiwan. J Formos Med Assoc. 2003;102:459–64.PubMed
27.
Zurück zum Zitat Lee WJ, Huang MT, Wang W, et al. Effects of obesity surgery on metabolic syndrome. Arch Surg. 2004;139:1088–92.PubMedCrossRef Lee WJ, Huang MT, Wang W, et al. Effects of obesity surgery on metabolic syndrome. Arch Surg. 2004;139:1088–92.PubMedCrossRef
28.
Zurück zum Zitat Sjostrom L, Narbro K, Sjostrom D, et al. Effect of bariatric surgery on mortality in Swedish obese subjects. NEJM. 2007;357:741–52.PubMedCrossRef Sjostrom L, Narbro K, Sjostrom D, et al. Effect of bariatric surgery on mortality in Swedish obese subjects. NEJM. 2007;357:741–52.PubMedCrossRef
29.
Zurück zum Zitat O’Brien PE, Dixon JB, Laurie, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program. Ann Intern Med. 2006;144:625–33.PubMed O’Brien PE, Dixon JB, Laurie, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program. Ann Intern Med. 2006;144:625–33.PubMed
Metadaten
Titel
Improvement of Insulin Resistance After Obesity Surgery: A Comparison of Gastric Banding and Bypass Procedures
verfasst von
Wei-Jei Lee
Yi-Chih Lee
Kong-Han Ser
Jung-Chien Chen
Shu Chung Chen
Publikationsdatum
01.09.2008
Verlag
Springer-Verlag
Erschienen in
Obesity Surgery / Ausgabe 9/2008
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-008-9457-3

Weitere Artikel der Ausgabe 9/2008

Obesity Surgery 9/2008 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.