Background
It is unclear whether specific gut microbiota is associated with remission of type 2 diabetes (T2D) after distinct types of bariatric surgery.
Aims
The aim of this study is to examine gut ...microbiota changes after laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery in obese patients with T2D.
Methods
Whole-metagenome shotgun sequencing of DNA fragments using Illumina HiSeq2000 was obtained from stool samples collected from 14 obese T2D patients pre-operatively (while on very low calorie diet) and 1 year after randomisation to laparoscopic SG (
n
= 7) or RYGB (
n
= 7). Resulting shotgun reads were annotated with Kyoto Encyclopedia of Genes and Genomes (KEGG).
Results
Body weight reduction and dietary change was similar 1 year after both surgery types. Identical proportions (
n
= 5/7) achieved diabetes remission (HbA1c < 48 mmol/mol without medications) 1 year after RYGB and SG. RYGB resulted in increased
Firmicutes
and
Actinobacteria
phyla but decreased
Bacteroidetes
phyla. SG resulted in increased
Bacteroidetes
phyla. Only an increase in
Roseburia
species was observed among those achieving diabetes remission, common to both surgery types. KEGG Orthology and pathway analysis predicted contrasting and greater gut microbiota metabolism changes after diabetes remission following RYGB than after SG. Those with persistent diabetes post-operatively had higher
Desulfovibrio
species pre-operatively.
Conclusions
Overall, RYGB produces greater and more predicted favourable changes in gut microbiota functional capacity than SG. An increase in
Roseburia
species was the only compositional change common to both types of surgery among those achieving diabetes remission.
Background
For bariatric surgery, patient selection, procedural choice and availability has changed over time internationally. We analysed the annual volume and location of bariatric surgery in New ...Zealand by demographic characteristics, clinical history and procedure.
Methods
Patients who underwent bariatric procedures between 1 January 2004 and 31 December 2017 were identified through New Zealand hospitalisation records. Hospitalisation and medication data were used to indicate a clinical history of cardiovascular disease (CVD) and/or diabetes. Publicly funded intervention rate by ethnicity was calculated using year- and sex-specific ethnic population estimates and obesity prevalence statistics.
Results
This study included 9109 patients, undergoing gastric bypass (GB,
n
= 3323) and sleeve gastrectomy (SG,
n
= 5452) as the most common procedures. Nationally, annual bariatric surgery volume increased in the public sector, from 34 to 516 between 2004 and 2017, with a similar increase in available private sector figures. Public recipients were significantly more likely to have a history of diabetes (33.8% vs 14.4%) and/or CVD (9.0% vs 4.7%) than private recipients. Male recipients had higher prevalence of diabetes (29.9% vs 17.6%) and CVD (12.9% vs 4.1%) than female recipients. After adjustment for the adult population prevalence of morbid obesity, Pacific people had half the intervention rate of European and Māori.
Conclusion
Bariatric surgery is increasing in frequency in New Zealand, with SG and GB being the most common procedures. Significant differences in patient characteristics exist between the public and private sectors. Ensuring equitable selection of publicly funded bariatric surgery candidates remains a challenge.
Dysbiosis is linked to human disease; therefore, gut microbiota modulation strategies provide an attractive means of correcting microbial imbalance to enhance human health. Because diet has a major ...influence on the composition, diversity, and metabolic capacity of the gut microbiota, numerous dietary intervention studies have been conducted to manipulate the gut microbiota to improve host outcomes and reduce disease risk. Emerging evidence suggests that interindividual variability in gut microbiota and host responsiveness exists, making it difficult to predict gut microbiota and host response to a given dietary intervention. This may, in turn, have implications on the consistency of results among studies and the perceived success or true efficacy of a dietary intervention in eliciting beneficial changes to the gut microbiota and human health.
Bariatric surgery is effective in the management of type 2 diabetes (T2D) and obesity; however, it is not clear whether Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) is the most effective ...procedure. This review compared T2D remission and weight loss in patients with T2D after GBP or SG. All human SG or GBP studies published in English between 1 Jan 2007 and 30 April 2012 reporting on BMI and T2D outcomes were included. Analyses were performed separately for the most frequent distinct time points reported after surgery. A total of 21 prospective (three randomised control trials) and 12 retrospective studies, involving 1375 patients met eligibility criteria. T2D remission defined by hemoglobin A1
c
of <6.5 % for GBP and SG respectively was 67 and 56 % at 3 months, 76 and 68 % at 12 months, and 81 and 80 % at 36 months. Greater percent excess BMI loss occurred at 12 months (72.5 % after GBP and 66.7 % after SG) compared with 3 months (45.9 % after GBP and 25.9 % after SG). There was no significant difference in either T2D remission or weight loss with GBP compared with SG. Both GBP and SG result in similar early remission of T2D in 67 and 56 % of patients at 3 months respectively with modest additional T2D remission with time, although weight loss with both procedures increase substantially between 3 and 12 months post-operatively. Further randomised controlled trials comparing SG and GBP in patients with T2D using comparable definitions of diabetes remission with long-term follow-up are needed to evaluate relative benefits.
Long-term weight loss maintenance is often difficult to achieve. This review analysed qualitative data on self-perceived barriers and facilitators of weight loss and weight loss maintenance among ...weight loss intervention participants. A literature search was conducted using electronic databases. Qualitative studies written in English and published between 2011-2021 were eligible for inclusion if they explored the perspectives and experiences of individuals who received standardised dietary and behavioural support for weight loss. Studies were excluded if weight loss was achieved through self-directed methods, only increasing physical activity, or surgical or pharmacological interventions. Fourteen studies were included, totaling 501 participants from six countries. Thematic analysis was used to identify four aggregate themes: internal factors (i.e., motivation and self-efficacy), programme-specific factors (i.e., the intervention diet), social factors (i.e., supporters and saboteurs), and environmental factors (i.e., an obesogenic environment). Our findings demonstrate that internal, social, and environmental factors all influence weight loss success, as well as the acceptability of the weight loss intervention. Future interventions may be more successful if they prioritise participant acceptability and engagement by, for example, providing tailored interventions, a structured relapse management plan, strategies to enhance autonomous motivation and emotional self-regulation, and extended contact during weight loss maintenance.
Purpose
Distinct anatomical rearrangements of the gastrointestinal tract achieved by various types of bariatric surgery cause changes in nutrient intake and gut microbiota. The contribution of such ...gut microbiota changes to remission of type 2 diabetes (T2D) remains unclear.
Aim
We examined gut microbiota changes following banded Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in a randomised study, in relation to T2D remission.
Materials and Methods
Whole-metagenome shotgun sequencing was carried out on paired stool samples at pre- and 1-year post-surgery collected from 44 participants with T2D randomised to banded Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Taxonomic composition and predicted functional potential of the gut bacteria were identified using HUMANn2, and annotated using MetaCyc. Five-day dietary records (analysed using FoodWorks v8.0), body weight and diabetes status were recorded at both time points.
Results
RYGB participants had higher percentage excess weight loss than SG (
p
= 0.01), even though dietary intake was similar at 1-year post-surgery. Similar proportions achieved diabetes remission (HbA1c < 48 mmol/mol without medications) after either RYGB (68%) or SG (59%). RYGB resulted in increased abundances of Firmicutes and Proteobacteria, while SG resulted in increased Bacteroidetes. Pre-surgery, an increased abundance of Eubacteriaceae (
p
= 0.01) and
Alistipes putredinis
(
p
= 0.01) was observed in those who went on to remit from T2D post-surgery. Following surgery, Lachnospiraceae (
p
= 0.04) and
Roseburia
(
p
= 0.01) species were more abundant in those who had achieved T2D remission.
Conclusions
Specific stool bacterial taxa may signal likelihood of T2D remission after bariatric surgery which is potentially mediated by increases in
Lachnospiraceae
and
Roseburia
.
An association between diabetes mellitus (DM) and liver cirrhosis is well‐known, but estimates of the prevalence of DM in patients with liver cirrhosis vary widely. A systematic review was undertaken ...to determine the prevalence of DM in adult patients with liver cirrhosis. The Medline, EMBASE, and Cochrane Library databases were searched for peer‐reviewed studies published in English (1979‐2017) that investigated the prevalence of diabetes in adult patients with cirrhosis. Pooled estimates of prevalence of DM were determined for all eligible patients and according to aetiology and severity of liver disease. Fifty‐eight studies satisfied criteria for inclusion, with 9705 patients included in the pooled prevalence analysis. The overall prevalence of DM was 31%. The prevalence of DM was highest in patients with nonalcoholic fatty liver disease (56%), cryptogenic (51%), hepatitis C (32%), or alcoholic (27%) cirrhosis. For assessing prevalence of DM as a function of severity of liver disease, evaluable data were available only for hepatitis C and hepatitis B cirrhosis. DM may be more prevalent in cirrhosis than previously thought. This has implications for prognosis and treatment in these patients.
Both intermittent fasting and specific probiotics have shown promise in improving glucose tolerance with a potential for synergistic effects through alterations to gut microbiota. In this randomized, ...double-blinded, two-arm feasibility study, we investigated whether intermittent fasting, supplemented with
HN001 probiotic, reduces HbA1c in individuals with prediabetes. All participants with HbA1c 40-50 mmol/mol commenced intermittent fasting (2 days per week of calorie restriction to 600-650 kcal/day) and were randomized 1:1 to either daily probiotic (
HN001) or placebo for 12 weeks. The primary outcome was a change in HbA1c. Secondary outcomes included changes in anthropometry, body composition, glucoregulatory markers, lipids, hunger hormones, liver enzymes, inflammatory markers, gut hormones, calorie and macronutrient intake, quality of life, hunger, mood and eating behavior. Of 33 participants who commenced the trial, 26 participants (mean age 52 years, body mass index (BMI) 34.7 kg/m
) completed the intervention (
= 11 placebo,
= 15 probiotic). HbA1c decreased from 43 ± 2.7 mmol/mol to 41 ± 2.3 mmol/mol,
< 0.001, with average of 5% weight loss. No significant between-group differences were seen in primary or secondary outcomes except for social functioning (
= 0.050) and mental health (
= 0.007) scores as improvements were seen in the probiotic group, but not in the placebo group. This study shows additional psychological benefits of probiotic supplementation during intermittent fasting to achieve weight loss and glycemic improvement in prediabetes.
The CREBRF missense variant (p.Arg457Gln) is paradoxically associated with lower risk of type 2 diabetes, yet higher body mass index (BMI). Here we sought to determine whether this CREBRF variant ...might be associated with adult height.
Linear regression was used to analyse the association of the CREBRF minor (A) allele with height in 2286 Māori and Pacific adults living in Aotearoa/New Zealand. A potential type 2 diabetes index event was corrected to account for a bias that may be the cause of paradoxical association between the CREBRF diabetes-protective allele and higher BMI and height.
The CREBRF protective allele was associated with increased adult height (ß = 1.25 cm, P = 3.9 × 10
), with the effect being more pronounced in males. The lower odds of diabetes remained similar when analyses were adjusted for height (OR = 0.67-0.65). We found no evidence of a diabetes index event bias to explain the paradoxical effect of CREBRF with either BMI or height and diabetes. The orthologous CREBRF p.Arg457Gln variant was created in knock-in mice to independently assess the effect of the variant, and length was found to be greater in male mice at 8 weeks of age.
These data taken together indicate that CREBRF p.Arg457Gln is associated with taller stature in Māori and Pacific adults.
To assess diabetes eye service use in New Zealand among people aged ≥15 years by estimating service attendance, biennial screening rate, and disparities in the use of screening and treatment ...services.
We obtained Ministry of Health data from the National Non-Admitted Patient Collection on diabetes eye service events between 1 July 2006 and 31 December 2019 and sociodemographic and mortality data from the Virtual Diabetes Register and linked these using a unique patient identifier (encrypted National Health Index). We 1) summarized attendance at retinal screening and ophthalmology services, 2) calculated biennial and triennial screening rate, 3) summarized treatment with laser and anti-VEGF and used log-binomial regression to examine associations of all of these with age group, ethnicity, and area-level deprivation.
In total, 245,844 people aged ≥15 years had at least one diabetes eye service appointment attended or scheduled; half of these (n = 125,821, 51.2%) attended only retinal screening, one-sixth attended only ophthalmology (n = 35,883, 14.6%) and one-third attended both (n = 78,300, 31.8%). The biennial retinal screening rate was 62.1%, with large regional variation (73.9% in Southern District to 29.2% in West Coast). Compared with NZ Europeans, Māori were approximately twice as likely to never receive diabetes eye care or to access ophthalmology when referred from retinal screening, 9% relatively less likely to receive biennial screening and received the fewest anti-VEGF injections when treatment was commenced. Disparities in service access were also present for Pacific Peoples compared to NZ Europeans, younger and older age groups compared to those aged 50-59 years and those living in areas with higher deprivation.
Access to diabetes eye care is suboptimal, with substantial disparity between age groups, ethnicity groups, area level deprivation quintile and across districts. Efforts to improve access to and quality of diabetes eye care services must include strengthening data collection and monitoring.
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