Top

Published in:

01-07-2011 | Clinical Research

Improvement of Insulin Resistance and Reduction of Cardiovascular Risk Among Obese Patients with Type 2 Diabetes with the Duodenojejunal Bypass Liner

Authors: Eduardo Guimarães Hourneaux de Moura, Ivan Roberto Bonotto Orso, Bruno da Costa Martins, Guilherme Sauniti Lopes, Suzana Lopes de Oliveira, Manoel dos Passos Galvão-Neto, Marcio Correa Mancini, Marco Aurélio Santo, Paulo Sakai, Almino Cardoso Ramos, Arthur Belarmino Garrido-Júnior, Alfredo Halpern, Ivan Cecconello

Published in: Obesity Surgery | Issue 7/2011

Abstract

Background

This study aims to evaluate the effectiveness of the duodenojejunal bypass liner (DJBL) in the improvement of insulin resistance and reduction of cardiovascular risk among morbidly obese patients with type 2 diabetes mellitus, using the triglyceride/high-density lipoprotein (HDL) cholesterol ratio, percentage of weight loss, and glycemic control.

Methods

We used the TG/HDL ratio with a cutoff value of 3.5 to identify patients with insulin resistance. The value of the initial ratio was compared with the ratio obtained 6 months after implantation to evaluate whether an improvement in insulin resistance occurred. We also evaluated the improvement of glycated hemoglobin levels and the weight loss resulted from the use of the device and correlated that with the improvement of the TG/HDL ratio.

Results

All patients implanted with the device presented a statistically significant reduction of the HbA1c levels, with most patients (70.3%) obtaining diabetes control with HbA1c levels lower than 7% at the end of the study. All patients also presented a significant weight reduction, with an average loss of 12.6% of their initial weight. We observed an important improvement in insulin resistance and metabolic syndrome, with a significant reduction of the TG/HDL ratio from 5.75 to 4.36 (p < 0.001) and 42.6% of the patients presenting a TG/HDL ratio lower than 3.5 at the end of the study.

Conclusions

The DJBL, when used for a period of 6 months, is effective in the control of diabetes, weight loss, improvement of insulin resistance, and decrease of cardiovascular risk among morbidly obese patients with type 2 diabetes mellitus.

Bogers RP, Bemelmans WJ, Hoogenveen RT, et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. Arch Intern Med. 2007;167(16):1720–8.PubMedCrossRef

McLaughlin T, Abbasi F, Cheal K, et al. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med. 2003;139:802–9.PubMed

Shishehbor MH, Hoogwef BJ, Lauer MS. Association of triglyceride to HDL cholesterol ratio with heart rate recovery. Diabetes Care. 2004;27(4):936–41.PubMedCrossRef

McLaughlin T, Reaven G, Abbasi F, et al. Is there a simple way to identify insulin resistant individuals at increased risk of cardiovascular disease? Am J Cardiol. 2005;96(3):399–404.PubMedCrossRef

Tong PC, Kong AP, So WY, et al. The usefulness of the international diabetes federation and the national cholesterol education program’s Adult Treatment Panel III definitions of the metabolic syndrome in predicting coronary heart disease in subjects with type 2 diabetes. Diabetes Care. 2007;30(5):1206–11.PubMedCrossRef

Hadaegh F, Dhalili D, Ghasemi A, et al. Triglyceride/HDL cholesterol ratio is an independent predictor for coronary heart disease in a population of Iranian men. Nutr Metab Cardiovasc Dis. 2009;19(6):401–8.PubMedCrossRef

Vasques ACJ, Rosado LEFPM, Rosado GP, et al. Indicadores do perfil lipídico plasmático relacionados à resistência á insulina. Rev Assoc Méd Bras. 2009;55(3):342–6.PubMedCrossRef

Gersin KS, Keller JE, Stefanidis D, et al. Duodenal–jejunal bypass sleeve: a totally endoscopic device for the treatment of morbid obesity. Surg Innov. 2007;14(4):275–8.PubMedCrossRef

Schauer P, Chand B, Brethauer S. New applications for endoscopy: the emerging field of endoluminal and transgastric bariatric surgery. Surg Endosc. 2007;21:347–56.PubMedCrossRef

10.

Tarnoff M, Shikora S, Lembo A, et al. Chronic in-vivo experience with an endoscopically delivered and retrieved duodenal–jejunal bypass sleeve in a porcine model. Surg Endosc. 2008;22(4):1023–8.PubMedCrossRef

11.

Tarnoff M, Shikora S, Lembo A. Acute technical feasibility of an endoscopic duodenal–jejunal bypass sleeve in a porcine model: a potentially novel treatment for obesity and type 2 diabetes. Surg Endosc. 2008;22(3):772–6.PubMedCrossRef

12.

Tarnoff M, Rodriguez L, Escalona A, et al. Open label, prospective, randomized controlled trial of an endoscopic duodenal–jejunal bypass sleeve versus low calorie diet for pre-operative weight loss in bariatric surgery. Surg Endosc. 2009;23(3):650–6.PubMedCrossRef

13.

Rodriguez-Grunert L, Galvao Neto MP, Alamo M, et al. First human experience with endoscopically delivered and retrieved duodenal–jejunal bypass sleeve. Surg Obes Relat Dis. 2008;4(1):55–9.PubMedCrossRef

14.

Rodriguez L, Reyes E, Fagalde P, et al. Pilot clinical study of an endoscopic, removable duodenal–jejunal bypass liner for the treatment of type 2 diabetes. Diabetes Technol Ther. 2009;11(11):725–32.PubMedCrossRef

15.

Schouten R, Rijs CS, Bouvy ND, et al. A multicenter, randomized efficacy study of the EndoBarrier Gastrointestinal Liner for presurgical weight loss prior to bariatric surgery. Ann Surg. 2010;251(2):236–43.PubMedCrossRef

16.

Quizada Z, Paoli M, Zerpa Y, et al. The triglyceride/HDL cholesterol ratio as a marker of cardiovascular risk in obese children; association with traditional and emergent risk factors. Pediatr Diabetes. 2008;9(5):464–71.CrossRef

17.

Kannel WB, Vasan RS, Keyes MJ, et al. Usefulness of the triglyceride high density lipoprotein versus the cholesterol high density lipoprotein ratio for predicting insulin resistance and cardiometabolic risk (from the Framingham Offspring Cohort). Am J Cardiol. 2008;101(4):497–501.PubMedCrossRef

18.

Williams DB, Hagedorn JC, Lawson EH, et al. Gastric bypass reduces biochemical cardiac risk factors. Surg Obes Relat Dis. 2007;3:8–13.PubMedCrossRef

Title: Improvement of Insulin Resistance and Reduction of Cardiovascular Risk Among Obese Patients with Type 2 Diabetes with the Duodenojejunal Bypass Liner
Authors: Eduardo Guimarães Hourneaux de Moura
Ivan Roberto Bonotto Orso
Bruno da Costa Martins
Guilherme Sauniti Lopes
Suzana Lopes de Oliveira
Manoel dos Passos Galvão-Neto
Marcio Correa Mancini
Marco Aurélio Santo
Paulo Sakai
Almino Cardoso Ramos
Arthur Belarmino Garrido-Júnior
Alfredo Halpern
Ivan Cecconello
Publication date: 01-07-2011
Publisher: Springer-Verlag
Published in: Obesity Surgery / Issue 7/2011
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-011-0387-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Improvement of Insulin Resistance and Reduction of Cardiovascular Risk Among Obese Patients with Type 2 Diabetes with the Duodenojejunal Bypass Liner

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2011

A Model for Predicting the Resolution of Type 2 Diabetes in Severely Obese Subjects Following Roux-en Y Gastric Bypass Surgery

The Use of an Improved Intragastric Balloon Technique to Reduce Weight in Pre-obese Patients—Preliminary Results

Early Improvement in Glycemic Control After Bariatric Surgery and Its Relationships with Insulin, GLP-1, and Glucagon Secretion in Type 2 Diabetic Patients

Effects of Sleeve Gastrectomy and Medical Treatment for Obesity on Glucagon-like Peptide 1 Levels and Glucose Homeostasis in Non-diabetic Subjects

Revision to Malabsorptive Roux-En-Y Gastric Bypass (MRNYGBP) Provides Long-Term (10 Years) Durable Weight Loss in Patients with Failed Anatomically Intact Gastric Restrictive Operations

Traditional Versus Single-site Placement of Adjustable Gastric Banding: A Comparative Study and Cost Analysis