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Change Profiles and Functional Targets of MicroRNAs in Type 2 Diabetes Mellitus Patients with Obesity
Guanhua Lu, Huanhuan Gao, Zhiyong Dong, Shuwen Jiang, Ruixiang Hu, Cunchuan Wang
Diabetes Metab J. 2023;47(4):559-570.   Published online April 25, 2023
DOI: https://doi.org/10.4093/dmj.2022.0226
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
MicroRNAs (miRNAs) exert an essential contribution to obesity and type 2 diabetes mellitus (T2DM). This study aimed to investigate the differences of miRNAs in the presence and absence of T2DM in patients with obesity, as well as before and after bariatric surgery in T2DM patients with obesity. Characterization of the common changes in both was further analyzed.
Methods
We enrolled 15 patients with obesity but without T2DM and 15 patients with both obesity and T2DM. Their preoperative clinical data and serum samples were collected, as well as 1 month after bariatric surgery. The serum samples were analyzed by miRNA sequencing, and the miRNAs profiles and target genes characteristics were compared.
Results
Patients with T2DM had 16 up-regulated and 32 down-regulated miRNAs compared to patients without T2DM. Improvement in metabolic metrics after bariatric surgery of T2DM patients with obesity was correlated with changes in miRNAs, as evidenced by the upregulation of 20 miRNAs and the downregulation of 30 miRNAs. Analysis of the two miRNAs profiles identified seven intersecting miRNAs that showed opposite changes. The target genes of these seven miRNAs were substantially enriched in terms or pathways associated with T2DM.
Conclusion
We determined the expression profiles of miRNAs in the obese population, with and without diabetes, before and after bariatric surgery. The miRNAs that intersected in the two comparisons were discovered. Both the miRNAs discovered and their target genes were closely associated with T2DM, demonstrating that they might be potential targets for the regulation of T2DM.
Technology/Device
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Glucose Profiles Assessed by Intermittently Scanned Continuous Glucose Monitoring System during the Perioperative Period of Metabolic Surgery
Kyuho Kim, Sung Hee Choi, Hak Chul Jang, Young Suk Park, Tae Jung Oh
Diabetes Metab J. 2022;46(5):713-721.   Published online January 24, 2022
DOI: https://doi.org/10.4093/dmj.2021.0164
  • 5,331 View
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  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Continuous glucose monitoring (CGM) has been widely used in the management of diabetes. However, the usefulness and detailed data during perioperative status were not well studied. In this study, we described the immediate changes of glucose profiles after metabolic surgery using intermittently scanned CGM (isCGM) in individuals with type 2 diabetes mellitus (T2DM).
Methods
This was a prospective, single-center, single-arm study including 20 participants with T2DM. The isCGM (FreeStyle Libre CGM) implantation was performed within 2 weeks before surgery. We compared CGM metrics of 3 days before surgery and 3 days after surgery, and performed the correlation analyses with clinical variables.
Results
The mean glucose significantly decreased after surgery (147.0±40.4 to 95.5±17.1 mg/dL, P<0.001). Time in range (TIR; 70 to 180 mg/dL) did not significantly change after surgery in total. However, it was significantly increased in a subgroup of individuals with glycosylated hemoglobin (HbA1c) ≥8.0%. Time above range (>250 or 180 mg/dL) was significantly decreased in total. In contrast, time below range (<70 or 54 mg/dL) was significantly increased in total and especially in a subgroup of individuals with HbA1c <8.0% after surgery. The coefficient of variation significantly decreased after surgery. Higher baseline HbA1c was correlated with greater improvement in TIR (rho=0.607, P=0.005).
Conclusion
The isCGM identified improvement of mean glucose and glycemic variability, and increase of hypoglycemia after metabolic surgery, but TIR was not significantly changed after surgery. We detected an increase of TIR only in individuals with HbA1c ≥8.0%.

Citations

Citations to this article as recorded by  
  • Comparative Effect of Glucose-Lowering Drugs for Type 2 Diabetes Mellitus on Stroke Prevention: A Systematic Review and Network Meta-Analysis
    Ji Soo Kim, Gyeongsil Lee, Kyung-Il Park, Seung-Won Oh
    Diabetes & Metabolism Journal.2024; 48(2): 312.     CrossRef
  • Use of Continuous Glucose Monitoring in Patients Following Bariatric Surgery: A Scoping Review
    Yang Yu, Susan W. Groth
    Obesity Surgery.2023; 33(8): 2573.     CrossRef
  • Asymptomatic Hypoglycemia after Metabolic Surgery: New Insights from Perioperative Continuous Glucose Monitoring
    Sang-Man Jin
    Diabetes & Metabolism Journal.2022; 46(5): 675.     CrossRef
Reviews
Obesity and Metabolic Syndrome
Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia
Wei-Jei Lee, Lwin Aung
Diabetes Metab J. 2016;40(6):433-443.   Published online December 2, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.433
  • 4,267 View
  • 75 Download
  • 15 Web of Science
  • 16 Crossref
AbstractAbstract PDFPubReader   

Type 2 diabetes mellitus (T2DM) is a current global health priority and Asia is the epicenter of this epidemic disease. Unlike in the west, where older population is most affected, the burden of diabetes in Asian countries is disproportionately high in young to middle-age adults. The incidence of diabetic nephropathy is alarmingly high in patients with early onset T2DM, especially in those with poor glycemic control. How to control this chronic and debilitating disease is currently a very important health issue in Asia. Bariatric surgery has proven successful in treating not just obesity but also T2DM in morbid obese patients (body mass index [BMI] >35 kg/m2). Gastrointestinal metabolic surgery recently has been proposed as a new treatment modality for obesity related T2DM for patients with BMI <35 kg/m2. Many studies from Asia reported promising results of metabolic surgery to treat obese patients with T2DM which is not well controlled. It has been demonstrated that changes in gastrointestinal hormone secretion after gastrointestinal surgery would favor an early improvement of T2DM in Asians. New procedures have also been designed and proposed specifically for the treatment of diabetes in Asia. This article examines clinical trial data and accepted algorithms with a view toward elucidating the application of metabolic surgery for the treatment of T2DM in the Asia. We propose a systematic approach to surgical treatment, addressing current evidences, patient selection, procedure of choice, and timing and guideline for new procedures.

Citations

Citations to this article as recorded by  
  • Insulin resistance levels predicted metabolic improvement and weight loss after metabolic surgery in Chinese patients with type 2 diabetes
    Yaoquan Cao, Ping Luo, Haibo Tang, Pengzhou Li, Guohui Wang, Weizheng Li, Zhi Song, Zhihong Su, Xulong Sun, Xianhao Yi, Zhibing Fu, Beibei Cui, Shaihong Zhu, Liyong Zhu
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    Scientific Reports.2021;[Epub]     CrossRef
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    Salahedeen Abusnana, Mohammad Fargaly, Shaima Hasan Alfardan, Fatema Hasan Al Hammadi, Alaaeldin Bashier, Ghaida Kaddaha, Barbara McGowan, Rita Nawar, Amena Sadiya
    Obesity Facts.2018; 11(5): 413.     CrossRef
  • Laparoscopic sleeve gastrectomy combined with single-anastomosis duodenal-jejunal bypass in the treatment of type 2 diabetes mellitus of patients with body mass index higher than 27.5 kg/m2 but lower than 32.5 kg/m2
    Ying-Xu Li, Deng-Hua Fang, Tian-Xi Liu
    Medicine.2018; 97(31): e11537.     CrossRef
  • Comparison of Great Curvature Plication with Duodenal-Jejunal Bypass (GCP-DJB) and Sleeve Gastrectomy (SG) on Metabolic Indices and Gut Hormones in Type 2 Diabetes Mellitus Rats
    Nian-Cun Qiu, Wei Li, Miao-E Liu, Xiao-Xia Cen, Cheng-Xiang Shan, Wei Zhang, Qing Liu, Yang Wang, Ya-Ting Zhu, Ming Qiu
    Obesity Surgery.2018; 28(12): 4014.     CrossRef
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    Ivy H.Y. Ng, Kitty K.T. Cheung, Tiffany T.L. Yau, Elaine Chow, Risa Ozaki, Juliana C.N. Chan
    Endocrinology and Metabolism.2018; 33(1): 17.     CrossRef
  • Ethnicity Does Not Influence Glycemic Outcomes or Diabetes Remission After Sleeve Gastrectomy or Gastric Bypass in a Multiethnic Asian Cohort
    Phong Ching Lee, Kwang Wei Tham, Sonali Ganguly, Hong Chang Tan, Alvin Kim Hock Eng, John B. Dixon
    Obesity Surgery.2018; 28(6): 1511.     CrossRef
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    Xiao-Jun Cai, Lei Wang, Chun-Mei Hu
    Bioscience Reports.2018;[Epub]     CrossRef
  • Metabolic surgery ameliorates cardiovascular risk in obese diabetic patients: Influence of different surgical procedures
    Jih-Hua Wei, Ruey-Hsing Chou, Po-Hsun Huang, Wei-Jei Lee, Shu-Chun Chen, Shing-Jong Lin
    Surgery for Obesity and Related Diseases.2018; 14(12): 1832.     CrossRef
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Complications
The Effect of Bariatric Surgery on Diabetic Retinopathy: Good, Bad, or Both?
Dora M. Gorman, Carel W. le Roux, Neil G. Docherty
Diabetes Metab J. 2016;40(5):354-364.   Published online September 27, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.5.354
  • 4,589 View
  • 49 Download
  • 24 Web of Science
  • 28 Crossref
AbstractAbstract PDFPubReader   

Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes. This review aims to collate the recent data on retinal outcomes after bariatric surgery. This comprehensive evaluation revealed that the majority of DR cases remain stable after surgery. However, risk of progression of pre-existing DR and the development of new DR is not eliminated by surgery. Instances of regression of DR are also noted. Potential risk factors for deterioration include severity of DR at the time of surgery and the magnitude of glycated hemoglobin reduction. Concerns also exist over the detrimental effects of postprandial hypoglycemia after surgery. In vivo studies evaluating the chronology of DR development and the impact of bariatric surgery could provide clarity on the situation. For now, however, the effect of bariatric surgery on DR remains inconclusive.

Citations

Citations to this article as recorded by  
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    Karl Hage, Omar M. Ghanem
    Surgery for Obesity and Related Diseases.2024; 20(5): 499.     CrossRef
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  • The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis
    Binwu Sheng, Khoa Truong, Hugh Spitler, Lu Zhang, Xuetao Tong, Liwei Chen
    Obesity Surgery.2017; 27(10): 2724.     CrossRef
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    M. A. Stefater, T. H. Inge
    Current Diabetes Reports.2017;[Epub]     CrossRef
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A Gut Feeling to Cure Diabetes: Potential Mechanisms of Diabetes Remission after Bariatric Surgery
Young Min Cho
Diabetes Metab J. 2014;38(6):406-415.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.406
  • 5,519 View
  • 58 Download
  • 54 Web of Science
  • 42 Crossref
AbstractAbstract PDFPubReader   

A cure for type 2 diabetes was once a mere dream but has now become a tangible and achievable goal with the unforeseen success of bariatric surgery in the treatment of both obesity and type 2 diabetes. Popular bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy exhibit high rates of diabetes remission or marked improvement in glycemic control. However, the mechanism of diabetes remission following these procedures is still elusive and appears to be very complex and encompasses multiple anatomical and physiological changes. In this article, calorie restriction, improved β-cell function, improved insulin sensitivity, and alterations in gut physiology, bile acid metabolism, and gut microbiota are reviewed as potential mechanisms of diabetes remission after Roux-en-Y gastric bypass and sleeve gastrectomy.

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    Arkiath V Raveendran
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Diabetes Metab J : Diabetes & Metabolism Journal
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