Biliopancreatic diversion in patients with type 2 diabetes and moderate obesity: impact and mechanisms.

Context Diabetes remission is frequent after biliopancreatic diversion (BPD) in morbidly obese patients with type 2 diabetes (T2DM). Data, mechanisms, and clinical indications in nonobese T2DM patients are scanty. Objective To assess remission and investigate insulin sensitivity and ß-cell function after BPD in non-morbidly obese patients with long-standing T2DM. Design, setting and patients Clinical research study comparing 15 T2DM patients (age 551 years, duration 16±2 years, BMI=28.3±0.6 kg/m2, HbA1c=8.6±1.3%) with 15 gender-, age-, and BMI-matched nondiabetic controls. Before surgery, and 2 months and one year later, a 3-hour OGTT, a 5-hour mixed meal test, and a 3-hour euglycemic clamp were performed. Intervention BPD (gastric resection, distal jejunum anastomosed to remaining stomach, biliopancreatic tract anastomosed to ileum 75cm from the ileocecal valve). Results Glycemia improved in all patients, but remission (HbA1c<6.5% and normal OGTT) occurred in 6/15. Insulin resistance (19.8±0.8 µmol.min-1.kgffm-1, p<0.001 vs 40.9±5.3 of controls) resolved already at 2 months (34.2±2.8) and was sustained at one year (34.7±1.6), although insulin-mediated suppression of endogenous glucose production remained impaired. In contrast, ß-cell glucose sensitivity (19[12] pmol.min-1.m-2.mM-1 vs 96[73] of controls, p<0.0001) rose (p=0.02) only to 31[26] at one year, and was lower in non-remitters (16[18]) than remitters (46[33]). Conclusions In nonobese patients with long-standing T2DM, BPD improves metabolic control but induces remission in only ~30% of patients. Peripheral insulin sensitivity is restored early after surgery, and similarly in remitters and non-remitters, indicating a weight-independent effect of the operation. The initial extent of ß-cell incompetence is the main predictor of the metabolic outcome

Controle de Sphaerotheca fuliginea em abobrinha com resíduo da fermentação glutâmica do melaço e produto lácteo fermentado.

O resíduo da fermentação glutâmica do melaço (RFGM), comercializado como fertilizante, foi inicialmente testado a 1,5% e a 2,5% em três formas: cru; esterilizado; e fermentado por Bacillus subtilis, a 30 e 50%, para o controle do Oídio (Sphaerotheca fuliginea) da abobrinha. Em outros dois experimentos os tratamentos foram: RFGM; suspensão contendo alguns aminoácidos existentes no RFGM; e suspensão de sais com concentrações próximas ao RFGM, pulverizados duas vezes por semana, a 2,5%. Também foi estudado o produto da fermentação do leite com Lactobacillus, pulverizado duas vezes por semana, nas concentrações de 10, 20, 30, 40 e 50%. Posteriormente, esse produto foi testado na concentração de 10%, aplicado uma e duas vezes por semana. Em todos os ensaios os tratamentos foram comparados ao fenarimol 0,1 ml/l e a água. No primeiro ensaio, o controle obtido foi de 99, 91, 98, 88, 94, 98 e 98%, respectivamente para fenarimol; RFGM a 1,5 e 2,5%; RFGM esterilizado a 1,5 e 2,5%; RFGM fermentado por B. subtilis 30 e 50%. Em outro experimento o RFGM, a suspensão de sais e de aminoácidos controlaram a doenca em 85%, 72% e 15%, respectivamente, apresentando a mesma tendência quando de sua repetição. As porcentagens de controle foram de 95, 99, 99, 99 e 99, com o produto lácteo, nas concentrações de 10, 20, 30, 40 e 50%, respectivamente. Quando esse mesmo produto foi aplicado uma e duas vezes por semana, o controle foi de 75% e 91%, respectivamente; e o controle com fungicida foi 84%

Long-term effects of bariatric surgery on meal disposal and beta-cell function in diabetic and nondiabetic patients.

Gastric bypass surgery leads to marked improvements in glucose tolerance and insulin sensitivity in obese type 2 diabetes; the impact on glucose fluxes in response to a physiological stimulus - such as a mixed meal (MTT) - has not been determined. We administered an MTT to 12 obese type 2 diabetic patients (T2D) and 15 obese nondiabetic subjects (ND) before and one year after surgery (10 T2D and 11 ND) using the double-tracer technique and modeling of ß-cell function. In both groups postsurgery, tracer-derived appearance of oral glucose was biphasic, a rapid increase followed by a sharp drop, a pattern that was mirrored by postprandial glucose levels and insulin secretion. In diabetic patients, surgery lowered fasting and postprandial glucose levels; peripheral insulin sensitivity increased in proportion to weight loss (∼30%), ß-cell glucose sensitivity doubled but did not normalize (viz. 21 nonsurgical obese and lean controls). Endogenous glucose production, however, was less suppressed during the MMT as the combined result of a relative hyperglucagonemia and the rapid fall in plasma glucose and insulin levels.We conclude that, in type 2 diabetes bypass surgery changes the postprandial response to a dumping-like pattern, improves glucose tolerance, ß-cell function, and peripheral insulin sensitivity but worsens endogenous glucose output in response to a physiological stimulus

Muscle and adipose tissue morphology, insulin sensitivity and beta-cell function in diabetic and nondiabetic obese patients: effects of bariatric surgery

Obesity is characterized by insulin-resistance (IR), enhanced lipolysis, and ectopic, inflamed fat. We related the histology of subcutaneous (SAT), visceral fat (VAT), and skeletal muscle to the metabolic abnormalities, and tested their mutual changes after bariatric surgery in type 2 diabetic (T2D) and weight-matched non-diabetic (ND) patients. We measured IR (insulin clamp), lipolysis ((2)H5-glycerol infusion), ß-cell glucose-sensitivity (ß-GS, mathematical modeling), and VAT, SAT, and rectus abdominis histology (light and electron microscopy). Presurgery, SAT and VAT showed signs of fibrosis/necrosis, small mitochondria, free interstitial lipids, thickened capillary basement membrane. Compared to ND, T2D had impaired ß-GS, intracapillary neutrophils and higher intramyocellular fat, adipocyte area in VAT, crown-like structures (CLS) in VAT and SAT with rare structures (cyst-like) ~10-fold larger than CLS. Fat expansion was associated with enhanced lipolysis and IR. VAT histology and intramyocellular fat were related to impaired ß-GS. Postsurgery, IR and lipolysis improved in all, ß-GS improved in T2D. Muscle fat infiltration was reduced, adipocytes were smaller and richer in mitochondria, and CLS density in SAT was reduced. In conclusion, IR improves proportionally to weight loss but remains subnormal, whilst SAT and muscle changes disappear. In T2D postsurgery, some VAT pathology persists and beta-cell dysfunction improves but is not normalized

A specific gut microbiota signature is associated with an enhanced GLP-1 and GLP-2 secretion and improved metabolic control in patients with type 2 diabetes after metabolic Roux-en-Y gastric bypass

Objective: To determine changes in incretins, systemic inflammation, intestinal permeability and microbiome modifications 12 months after metabolic RYGB (mRYGB) in patients with type 2 diabetes (T2D) and their relationship with metabolic improvement. Materials and methods: Prospective single-center non-randomized controlled study, including patients with class II-III obesity and T2D undergoing mRYGB. At baseline and one year after surgery we performed body composition measurements, biochemical analysis, a meal tolerance test (MTT) and lipid test (LT) with determination of the area under the curve (AUC) for insulin, C-peptide, GLP-1, GLP-2, and fasting determinations of succinate, zonulin, IL-6 and study of gut microbiota. Results: Thirteen patients aged 52.6 ± 6.5 years, BMI 39.3 ± 1.4 kg/m2, HbA1c 7.62 ± 1.5% were evaluated. After mRYGB, zonulin decreased and an increase in AUC after MTT was observed for GLP-1 (pre 9371 ± 5973 vs post 15788 ± 8021 pM, P<0.05), GLP-2 (pre 732 ± 182 vs post 1190 ± 447 ng/ml, P<0.001) and C- peptide, as well as after LT. Species belonging to Streptococaceae, Akkermansiacea, Rickenellaceae, Sutterellaceae, Enterobacteriaceae, Oscillospiraceae, Veillonellaceae, Enterobacterales_uc, and Fusobacteriaceae families increased after intervention and correlated positively with AUC of GLP-1 and GLP-2, and negatively with glucose, HbA1c, triglycerides and adiposity markers. Clostridium perfringens and Roseburia sp. 40_7 behaved similarly. In contrast, some species belonging to Lachnospiraceae, Erysipelotricaceae, and Rumnicocaceae families decreased and showed opposite correlations. Higher initial C-peptide was the only predictor for T2D remission, which was achieved in 69% of patients. Conclusions: Patients with obesity and T2D submitted to mRYGB show an enhanced incretin response, a reduced gut permeability and a metabolic improvement, associated with a specific microbiota signature

A specific gut microbiota signature is associated with an enhanced GLP-1 and GLP-2 secretion and improved metabolic control in patients with type 2 diabetes after metabolic Roux-en-Y gastric bypass

ObjectiveTo determine changes in incretins, systemic inflammation, intestinal permeability and microbiome modifications 12 months after metabolic RYGB (mRYGB) in patients with type 2 diabetes (T2D) and their relationship with metabolic improvement.Materials and methodsProspective single-center non-randomized controlled study, including patients with class II-III obesity and T2D undergoing mRYGB. At baseline and one year after surgery we performed body composition measurements, biochemical analysis, a meal tolerance test (MTT) and lipid test (LT) with determination of the area under the curve (AUC) for insulin, C-peptide, GLP-1, GLP-2, and fasting determinations of succinate, zonulin, IL-6 and study of gut microbiota.ResultsThirteen patients aged 52.6 ± 6.5 years, BMI 39.3 ± 1.4 kg/m2, HbA1c 7.62 ± 1.5% were evaluated. After mRYGB, zonulin decreased and an increase in AUC after MTT was observed for GLP-1 (pre 9371 ± 5973 vs post 15788 ± 8021 pM, P&lt;0.05), GLP-2 (pre 732 ± 182 vs post 1190 ± 447 ng/ml, P&lt;0.001) and C- peptide, as well as after LT. Species belonging to Streptococaceae, Akkermansiacea, Rickenellaceae, Sutterellaceae, Enterobacteriaceae, Oscillospiraceae, Veillonellaceae, Enterobacterales_uc, and Fusobacteriaceae families increased after intervention and correlated positively with AUC of GLP-1 and GLP-2, and negatively with glucose, HbA1c, triglycerides and adiposity markers. Clostridium perfringens and Roseburia sp. 40_7 behaved similarly. In contrast, some species belonging to Lachnospiraceae, Erysipelotricaceae, and Rumnicocaceae families decreased and showed opposite correlations. Higher initial C-peptide was the only predictor for T2D remission, which was achieved in 69% of patients.ConclusionsPatients with obesity and T2D submitted to mRYGB show an enhanced incretin response, a reduced gut permeability and a metabolic improvement, associated with a specific microbiota signature

Changes in glucagon‐like peptide 1 and 2 levels in people with obesity after a diet‐induced weight‐loss intervention are related to a specific microbiota signature: A prospective cohort study

The study was supported by grants from the Instituto de Salud Carlos III (PI14/00228, PI17/0153 and PI20/00338 to J.V.), Ministerio de Ciencia e Innovación (RTI2018- 093919-B-I00 to S.F.-V. and PID2019-105969GB-I00 to A.M) and Generalitat Valenciana (PROMETEO/2018/A/133 to A.M), co-financed by the European Regional Development Fund. The Spanish Biomedical Research Center in Diabetes and Associated Metabolic Disorders (CB07708/0012) is an initiative of the Instituto de Salud Carlos III. S.FV. acknowledges the Miguel Servet tenure-track program (CP10/00438 and CPII16/00008) from Fondo de Investigación Sanitaria.Peer reviewe

Controle de Sphaerotheca fuliginea da abóbora com leite.

Plantas de abóbora, com duas folhas verdadeiras, desenvolvidas na ausência de inóculo de Sphaerotheca fuliginea, foram transferidas para casa de vegetação com alto potencial de inóculo do patógeno, com a finalidade de avaliar o potencial do leite, como produto alternativo, no controle da doenca. Foram realizados quatro ensaios, em delineamento inteiramente casualizado, com 6 repetições; sendo considerada como repetição um vaso com uma planta. Os tratamentos estudados foram: água; fenarimol (Rubigan) 0,1 ml/l; e leite nas concentrações de 5, 10, 20, 30, 40, 50%. O leite foi obtido diretamente de produtor, antes do processamento. As pulverizações foram realizadas com auxilio de pistola de pintura, acoplada a compressor, sendo duas vezes por semana, nos três primeiros ensaios, exceto o fungicida que foi uma; e uma vez por semana para todos os tratamentos no quarto ensaio. As avaliações foram semanais determinando-se porcentagem de área foliar lesionada. As médias de controle obtidas, nos três primeiros ensaios, foram de 73,9; 88,7; 94,4; 95,2; 97,1; 96,9 e 82,1% para os tratamentos com leite nas concentrações de 5, 10, 20, 30, 40 e 50%; e fenarimol, respectivamente. No quarto ensaio, com pulverizações semanais o controle foi de 37,3; 74,6; 83,7; 85,3; 85,6; 91,4 e 86,0% para leite nas concentrações de 5, 10, 20, 30, 40 e 50%; e fenarimol, respectivamente. Os resultados obtidos permitem concluir que o leite apresenta potencial para o controle do oídio da abóbora.Made available in DSpace on 2017-01-04T23:00:15Z (GMT). No. of bitstreams: 1 1997AP031BettiolControle3403.PDF: 415854 bytes, checksum: 914fd62bb86844b6bc8a27119a8dc206 (MD5) Previous issue date: 1998-04-07199