ObjectiveTo investigate the effects of single anastomosis sleeve ileal (SASI) bypass on weight loss, metabolic improvements, and postoperative safety in patients with obesity and its metabolic comorbidities (such as type 2 diabetes and hyperlipidemia). MethodsA retrospective analysis was conducted. The clinical data of patients with obesity [body mass index (BMI) ≥32.5 kg/m2 or BMI ≥27.5 kg/m2 with metabolic diseases] who underwent SASI bypass in the Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2023 to December 2023. Weight loss outcomes, including the percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and percentage of excess BMI loss (%EBMIL), were recorded at 6 and 12 months postoperatively. Metabolic disease remission and complications at 12 months postoperatively were also documented. ResultsA total of 82 patients were included in the study. At 12 months postoperatively, the reductions in %TWL, %EWL, and %EBMIL were significantly greater than those observed at 6 months postoperatively [%TWL: (27.1±4.6)% vs. (23.6±3.8)%, t=2.379, P=0.026; %EWL: (72.1±5.8)% vs. (56.6±7.3)%, t=2.593, P<0.001; %EBMIL: (71.6±6.7)% vs. (58.3±4.9)%, t=2.607, P<0.001], remission was observed in 40 out of 48 patients (83.3%) with comorbid hypertension, 49 out of 51 patients (96.1%) with comorbid type 2 diabetes mellitus, and all patients with comorbid hyperlipidemia (33 cases) and obstructive sleep apnea syndrome (29 cases) achieved complete remission. Within 12 months after SASI bypass, 3 patients (3.7%) experienced melena, 2 patients (2.4%) developed incomplete intestinal obstruction, and 10 patients (12.1%) showed malnutrition. ConclusionThe findings of this study indicate that SASI bypass demonstrates significant weight loss and metabolic improvement effects in patients with obesity and metabolic diseases, with a controllable safety profile.
ObjectiveTo systematically evaluate effect of metformin on prognosis of colorectal cancer patients with type 2 diabetes mellitus (T2DM).MethodsThe PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, Wangfang, etc. databases for cohort studies over the past 10 years were systematically searched. The relationship between the metformin and the prognosis in the colorectal cancer patients with T2DM was assessed with RevMan 5.3 software.ResultsA total of 12 articles with 13 694 patients were included in this study, of which 9 069 patients treated by the metformin (metformin group) and 4 625 patients treated by the other antidiabetic agent (control group). The results of meta-analysis showed that the metformin group had higher over survival [HR=0.74, 95%CI (0.66, 0.82), P<0.000 01] and cancer-specific survival [HR=0.77, 95%CI (0.69, 0.86), P<0.000 01] as compared with the control group. The sensitivity analysis of the heterogeneity showed that the research results did not be changed when the study which might cause heterogeneity was excluded. ConclusionMetformin treatment could improve prognosis of colorectal cancer patients with T2DM and improve overall survival and cancer-specific survival.
Objective
To investigate effect of metabolic surgery on type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) 27.5–32.5 kg/m2.
Methods
The clinical data of 43 T2DM patients with BMI 27.5–32.5 kg/m2 underwent metabolic surgery from October 2014 to October 2016 in the Third Xiangya Hospital of Central South University were analyzed retrospectively. The related indexes such as BMI, blood glucose level, blood lipid level were analyzed before and after metabolic surgery.
Results
All the patients underwent metabolic surgery successfully. Among them, 35 cases underwent laparoscopic gastric bypass surgery while 8 cases underwent laparoscopic sleeve gastrectomy without related complications after operation. Compared with preoperative indexes, the BMI, fasting blood glucose, HbA1c, triglyceride, and total cholesterol on the postoperative different time were all significantly decreased (P<0.05) except for the HbA1c on the postoperative 1-week, the high density lipoprotein level on the postoperative 12-month was significantly increased (P<0.05). The OGTT 30, 60, and 120 min blood glucose levels on the postoperative 1-week and 3-month, and 60 and 120 min blood glucose levels on the postoperative 6-month and 12-month were all significantly decreased (P<0.05). The OGTT-IRT 60 min insulin level on the postoperative 3-month and the 30 min insulin levels on the postoperative 6- and 12-month were all significantly increased (P<0.05). The levels of OGTT-CRT 30 and 60 min C peptide on the postoperative 6-month and the level of 30 min C peptide on the postoperative 12-month were all significantly increased (P<0.05).
Conclusions
Metabolic surgery is effective in treatment of T2DM patients with BMI 27.5–32.5 kg/m2, and levels of blood glucose and blood lipids can be improved significantly. Synthesis and release of insulin by islet cells can be ameliorated.
ObjectiveTo investigate effects of sleeve gastrectomy (SG)-transit bipartition (SG-TB) and simple SG on bariatric and anti-diabetic and protective effect on esophagus reflux. MethodsA total of 36 male Sprague-Dawley rats were used to successfully induce the obesity with type 2 diabetes mellitus (T2DM) model by dietary feeding and receiving intraperitoneal injection of streptozotocin (35 mg/kg), then were randomly averagely divided into SG, SG-TB, and sham operation (SO) groups according to the surgical methods, and 8 rats from each procedure were randomly selected and included to use for experimental observation. The observation period was 12 weeks. The changes of terminal esophageal mucosa were observed at the 12th week after operation. The body weight and food intake were measured every 2 weeks after operation. The fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) blood glucose levels were measured before operation and at the 4th and 12th week after operation. And the changes of glucagon like peptide-1 (GLP-1) and insulin levels were measured before operation and at the 12th week after operation. ResultsThere were no significant differences in all indexes among the 3 groups before operation (P>0.05). ① No esophageal papillomatosis was observed in the SG-TB group at the 12th week after operation, but more severe esophageal papillomatosis was observed in the SG group, and the mucosal height in the SG-TB group was lower than that in the SG group (P<0.05). ② From the 4th week after operation, the body weight and food intake of the SG-TB group and SG group were lower than the SO group (P<0.05), and their changes of these two groups over time were generally stable. While no significant difference was found in the reduction of body weight between the SG-TB group and the SG group (P>0.05), however the food intakes of the SG-TB group were higher than the SG group at the 10th and 12th week after operation (P<0.05). ③ The levels of FBG, OGTT and ITT blood glucoses in the SG-TB group and SG group were lower than in the SO group at the 4th and 12th week after operation (P<0.05) and remained stable after operation. However, no significant difference was found in the FBG and ITT blood glucose level between the SG-TB group and the SG group (P>0.05), while the level of OGTT blood glucose in the SG-TB group was lower than that in the SG group at the 12th week after operation (P<0.05). ④ The levels of GLP-1 in the SG-TB group and SG group were higher than in the SO group and still higher than before operation (P<0.05), while the insulin levels were lower than in the SO group and lower than before operation (P<0.05). ConclusionsFrom preliminary results of this study, change of terminal esophageal mucosa after SG-TB is weaker than that of SG operation, and it is found that SG-TB surgery shows a better trend in blood glucose control as compared with SG operation. However, due to the limitations of sample size, further research and anti-reflux effect of SG-TB operation still need to be verified.
Objective To assess the improvement of different resistance training regimens on blood lipid metabolism and insulin resistance in patients with type 2 diabetes mellitus (T2DM). Methods PubMed, ProQuest, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases were searched to collect randomized controlled trials of resistance training intervention to improve blood lipids and insulin resistance in patients with T2DM. The search time range was from the establishment of the databases to May 2023. Two reviewers assessed the risk of bias of the included studies using the Physiotherapy Evidence Database scale, and performed a network meta-analysis of the extracted data using Stata 16.0 software. Results In the end, 24 articles were included, and a total of 983 participants were enrolled. The result of network meta-analysis showed that high-frequency and moderate-intensity resistance exercise significantly improved the levels of insulin resistance [standardized mean difference=?1.71, 95% confidence interval (CI) (?2.75, ?0.67)], triglycerides [weighted mean difference (WMD)=?0.27 mmol/L, 95%CI (?0.51, ?0.04) mmol/L], and total cholesterol [WMD=?0.16 mmol/L, 95%CI (?0.20, ?0.12) mmol/L], but had no significant effect on improving the level of high-density lipoprotein [WMD=0.05 mmol/L, 95%CI (?0.02, 0.11) mmol/L] or low-density lipoprotein [WMD=?0.20 mmol/L, 95%CI (?0.42, 0.03) mmol/L]. The results of cumulative probability ranking showed that high-frequency and moderate-intensity resistance exercise was the best in improving insulin resistance, triglycerides, high-density lipoprotein and low-density lipoprotein levels. Conclusion Based on current evidence, high-frequency and moderate-intensity resistance exercise may be the best resistance exercise regimen to improve insulin resistance and lipid metabolism in patients with T2DM.
Objective
To explore mechanism of gastric bypass in treating obesity with type 2 diabetes mellitus (T2DM) and its relationship with c-Jun N-terminal kinase (JNK) signaling pathway.
Methods
The INS-1 cells were divided into 4 groups according to the different treatment: control group (complete medium), high glucose group (30 mmol/L glucose medium), exendin-4 group (high glucose+100 nmol/L exendin-4), and JNK agonist group (high glucose+100 nmol/L exendin-4+JNK agonist). When these cells were cultured on day 7, the cell activity was assessed by the MTT staining. The cell apoptosis was determined by the fluorescence microscopy analysis after the Hoechst/PI staining and flow cytometric assay after the Annexin V-FITC/PI staining. The expressions of the human immunoglobulin binding protein (Bip), CCAAT/enhancer-binding protein homologous protein (CHOP), P-SAPK/JNK, and caspase-3 protein were detected by the Western blot.
Results
Compared with the control group, the cell activities were significantly decreased (P<0.05), the cell apoptosis rates and the P-SAPK/JNK and caspase-3 protein expression levels were significantly increased (P<0.01) in the high glucose group and the JNK agonist group, but the Bip and CHOP protein expression levels were significantly increased (P<0.01) in the high glucose group. Compared with the high glucose group, the cell activity was significantly increased (P<0.05), the cell apoptosis rate and the Bip, CHOP, P-SAPK/JNK, and caspase-3 protein expression levels were significantly decreased (P<0.01) in the exendin-4 group, the Bip and CHOP protein expression levels were significantly decreased (P<0.01) in the JNK agonist group. Compared with the exendin-4 group, the cell activity was significantly decreased (P<0.05), the cell apoptosis rate and the P-SAPK/JNK and caspase-3 protein expression levels were significantly increased (P<0.01) in the JNK agonist group.
Conclusion
Gastric bypass can inhibit endoplasmic reticulum stress of pancreatic islet β-cells by regulating secretion of glucagon like peptide-1, thereby inhibiting JNK signaling pathway, protecting pancreatic islet β-cells and inhibiting apoptosis, so as to achieve effect of treating T2DM.
Patients with type 2 diabetes mellitus often face significant treatment burden, which substantially impacts their quality of life and health outcomes. Reducing treatment burden represents a critical component for improving patient prognosis and enhancing treatment adherence. Based on the cumulative complexity model, this article systematically examines the conceptual connotation and multidimensional characteristics of treatment burden in type 2 diabetes mellitus patients, explores the theoretical extension and application value of cumulative complexity model in the type 2 diabetes mellitus field, elucidates its specific applications and recent advances in treatment burden research, evaluates the limitations of existing assessment tools while proposing a multidimensional assessment framework, and ultimately develops cumulative complexity model based intervention strategies. The findings provide theoretical references for optimizing patient-centered diabetes management approaches and offer novel perspectives for treatment burden intervention.
Objective To explore the potential molecular mechanism of Rhodiola crenulata (RC) for type 2 diabetes mellitus (T2DM) and Alzheimer’s disease (AD) by network pharmacology and molecular docking. Methods The target genes of T2DM and AD, the effective active components and targets of RC were identified through multiple public databases during March to August, 2022. The main active components and core genes of RC anti T2DM-AD were screened. The key genes were enrichment analyzed by gene ontology function and Kyoto gene and Kyoto Encyclopedia of Genes and Genomes. AutoDock Vina was used for molecular docking and binding energy calculation. Results A total of 5189 T2DM related genes and 1911 AD related genes were obtained, and the intersection result showed that there were 1418 T2DM-AD related genes. There were 48 active components of RC and 617 corresponding target genes. There were 220 crossing genes between RC and T2DM-AD. The main active components of RC anti T2DM-AD included kaempferol, velutin, and crenulatin. The key genes for regulation include ESR1, EGFR, and AKT1, which were mainly enriched in the hypoxia-inducible factor-1 signal pathway, estrogen signal pathway, and vascular endothelial growth factor signal pathway. The docking binding energies of the main active components of RC and key gene molecules were all less than ?1.2 kcal/mol (1 kcal=4.2 kJ). Conclusions RC may play a role in influencing T2DM and AD by regulating the hypoxia-inducible factor-1 signaling pathway, estrogen signaling pathway, and vascular endothelial growth factor signaling pathway.
Sleeve gastrectomy with transit bipartition (SG-TB) was a novel bariatric and metabolic surgery that had received preliminary approval for its effectiveness and safety in reducing weight, improving diabetes, and other metabolic diseases. It showed promising prospects in clinical applications. However, SG-TB also faced some challenges including a small number of cases, insufficient clinical evidence, issues with anastomotic stoma and common channel design, bile reflux, gastroesophageal reflux disease, and malnutrition. Further research is needed to enhance the standardization of SG-TB procedures and provides reference for its wider implementation.
Objective To explore the relationship between the triglyceride glucose-body mass index (TyG-BMI) and hypertension, type 2 diabetes, as well as their comorbidity, aiming to provide a scientific basis for the early identification and precise prevention of these three diseases. Methods This research collected data from subjects in the China Health and Retirement Longitudinal Study (CHARLS) database. According to the quartiles of TyG-BMI, the included subjects were divided into Q1 group, Q2 group, Q3 group, and Q4 group. Logistic regression was used to analyze the association between the TyG-BMI and the three diseases separately. Further, a restricted cubic spline model was employed to investigate the potential non-linear dose-response relationship between the TyG-BMI index and the three diseases. Subgroup analysis was conducted using interaction tests to investigate whether there was an interaction between TyG-BMI and subgroup factors such as age and gender. Results A total of 4 847 participants were included. There were 1 212 cases in Q1 group, 1 212 cases in Q2 group, 1 211 cases in Q3 group, and 1 212 cases in Q4 group. The logistic regression results indicate that, after adjusting for all confounding factors, participants in the Q4 group had a higher risk of developing type 2 diabetes, hypertension, and comorbidity of hypertension and type 2 diabetes in Model 3 (P<0.05). The results from the restricted cubic spline model demonstrated a linear relationship between the TyG-BMI index and the risk of type 2 diabetes (P for non-linearity >0.05), while a non-linear relationship was observed with hypertension (P for non-linearity <0.05) and the comorbidity of hypertension and type 2 diabetes (P for non-linearity <0.05). Subgroup analysis using interaction tests showed that compared to the Q1 group, factors such as age, gender, smoking, alcohol consumption, and dyslipidemia in the Q2, Q3, and Q4 groups did not significantly alter the relationship between TyG-BMI and type 2 diabetes, hypertension, and their comorbidity. Overall, there was no significant interaction between TyG-BMI and factors like age, gender, smoking, alcohol consumption, and dyslipidemia (P for interaction >0.05). Conclusions In middle-aged and elderly populations, the higher the TyG-BMI, the greater the risk of hypertension, type 2 diabetes, and their comorbidity. The TyG-BMI could be considered an important indicator for the early identification of hypertension, type 2 diabetes, and their comorbidities.
