Effects of gastroplasty on type 2 diabetes 2

OBESITY AND TYPE 2 DIABETES:

Explosion world of obesity and type 2 diabetes:

- 1.1 billion people in the world gold obese overweight 

- 1/3 population of industrial countries which france is overweight or bigeye. 

- The obesity complicates of comorbidity, the first is diabetes.

- 50% of type 2 diabetes are obese 

- lose 5 to 10% of weight can prevent the occurrence of diabetes

 

MECHANISMS OF TYPE 2 DIABETES:

- The insulin resistance in obese is the cause of frequent elevation of blood glucose.

- Diabetes is defined by blood sugar > 1.26 g / l

- Reduction of mass fat helps decrease the insulin resistance and blood sugar. 

 

WHAT MEANS FOR REGULATING? THE DT2 AMONG OBESE?

DIET: 
Decrease calorie intakes, but the limits and the periods of weight bounce of which we know after stop (yoyo syndrom)

MEDICINE:
First-line * metformine, and the inhibitors of the alpha glucosidase who decrease the intestinal absorption of the glucose

* The insulin drugs: - sulpha drugs, glinides - the inhibitors of the dpp4 - the analogues of the glp 1 which decrease the glycemia and decrease the fat mass but in a moderated way

*Insulin lastly and in association, when the precedents were insufficient. 

 

BARIATRIC SURGERY

Proposed is when the system is not monitoring and ineffective

when bmi > 35 associated comorbidities

when  bmi> 40

 

2 TYPES OF INTERVENTION:

- Techniques of gastric limitation:

-> the sleeve gastrectomy, gastrectomy longitudinal or sleeve gastrectomy

-> ring adjustable gastric, less current use

 

- The mixed media involvement of gastric restriction and bowel malabsorption:

-> the gastric bypass or short circuit gastric

-> the bilio pancreatic bypass

 

METABOLIC EFFECTS OF BARIATRIC SURGERY

SATIETOGENICS EFFECTS:

By decreasing gastric volume

Decreased secretion of GHRELIN hormone secreted by the stomach to orexigenic effects which reduces insulin sensitivity

Increased PYY (satiety hormone)

 

STANDARDIZATION INSULIN SENSITIVITY:

More insulin resistance is important preoperatively, the more it will decrease post

The operated T2DM increase their insulin secretion

purpose also increase their sensitivity to insulin:

Normoglycaemia fasting and postprandial

 

ROLE OF GLP1

GLP-1: glucagon-like peptide 1

- secreted by duodenum and ileum

- involved in glycaemic control

- its rate increase after rygbp

- improvement of the metabolic parameters comment operating 

- note on a glp1 peak post prandial fleeting  with the sleeve + rygbp

- discussed effects

 

THE MICROBIOTA

Plays an important role in weight homeostasis.

Bacterial digestive formed flora can be separated in two categories:

-bacteroides

-firmicutes

 

In the bigeye, family cast firmicutes, code for enzymes that increase gastrointestinal absorption

the bypass intestinal flora involved in altered:

-> genesis of obesity

-> increased bowel permeability

-> inflammation

-> the insulin resistance

-> translocate fragments to bacterial blood circulation

 

Goal is still evil known microbiota, variable population to another and the amended rygbp anaerobic flora.

The challenge is to show the flora of specific changes related to this surgery that could have an effect metabolic.

 

INFLAMMATION AND LIPOTOXICITY

THE DT2 IS CHARACTERISED BY:

-> Inflammatory processes.

-> Of ectopic fat deposition adipocytes off with production of ceramide or:

reduction of insulin sensitivity

increased insulin resistance

 

THE RYGBP

-> Depletion ectopic fat tissue by:

-> Decrease in the amount of lipids ingested

-> Lipid malabsorption

-> Increased lipid oxidation to provide the daily energy coverage.

 

REDUCING INFLAMMATION AFTER RYGBP

Bariatric surgery (RYGBP gold sleeve gastrectomy) is more effective we T2DM than medical treatments

Improvement of diabetes in 80% of cases (meta analysis Buch et al)

Proven by the decrease:

-> Blood glucose and hba1c

-> Of insulin and postprandial hypertriglyceridemia

-> The HOMA-IR index (index of insulin resistance)

Stopping oral and insulin therapies 

 

OTHER EFFECTS OF RYGBP

Increased intestinal glucose production

Decrease in hepatic glucose production

Increasing the sensitivity of peripheral tissue to insulin

the decrease in food intake via the central nervous system

 

Insulin resistance normalized within seven days post surgery

Importance of the autonomic nervous system (Vagus Nerve)

In rodents vagotomy cancels all the effects of bypass

 

IN PRACTICE

Bariatric surgery (RYGBP gold sleeve gastrectomy) is more effective we T2DM than medical treatments

Improvement of diabetes in 80% of cases (meta analysis Buch et al)

Proven by the decrease:

-> Blood glucose and hba1c

-> Of insulin and postprandial hypertriglyceridemia

-> The HOMA-IR index (index of insulin resistance)

Stopping oral and insulin therapies

 

 

CONCLUSION AND OUTLOOK

- The rygbp has spectacular effects of control effects of healing t2d (provided that the duration of diabetes less than 10 years)

- Profit is the resulting combined effects multiple metabolic

- Resumption of weight after 18 months in some due to compensation mechanisms (especially redifferentiation food shackle duodenum)

- Bariatric surgery may be regarded as a means of treatment and prevention of type 2 diabetes in the bigeye.