Adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery (GRAVITAS): a randomised, double-blind, placebo-controlled trial

Publication date: Available online 4 June 2019Source: The Lancet Diabetes &EndocrinologyAuthor(s): Alexander Dimitri Miras, Belén Pérez-Pevida, Madhawi Aldhwayan, Anna Kamocka, Emma Rose McGlone, Werd Al-Najim, Harvinder Chahal, Rachel L Batterham, Barbara McGowan, Omar Khan, Veronica Greener, Ahmed R Ahmed, Aviva Petrie, Samantha Scholtz, Stephen R Bloom, Tricia M TanSummaryBackgroundMany patients with type 2 diabetes do not achieve sustained diabetes remission after metabolic (bariatric) surgery for the treatment of obesity. Liraglutide, a glucagon-like peptide-1 analogue, improves glycaemic control and reduces bodyweight in patients with type 2 diabetes. Our aim was to assess the safety and efficacy of liraglutide 1·8 mg in patients with persistent or recurrent type 2 diabetes after metabolic surgery.MethodsIn the GRAVITAS randomised double-blind, placebo-controlled trial, we enrolled adults who had undergone Roux-en-Y gastric bypass or vertical sleeve gastrectomy and had persistent or recurrent type 2 diabetes with HbA1c levels higher than 48 mmol/mol (6·5%) at least 1 year after surgery from five hospitals in London, UK. Participants were randomly assigned (2:1) via a computer-generated sequence to either subcutaneous liraglutide 1·8 mg once daily or placebo, both given together with a reduced-calorie diet, aiming for a 500 kcal per day deficit from baseline energy intake, and increased physical activity. The primary outcome was the...
Source: The Lancet Diabetes and Endocrinology - Category: Endocrinology Source Type: research

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AbstractBackgroundTo compare changes in bone mineral density (BMD) in patients with morbid obesity and type 2 diabetes (T2D) a year after being randomized to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP). We also analyzed the association of gastrointestinal hormones with skeletal metabolism.MethodsForty-five patients with T2D (mean BMI 39.4  ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Before and 12  months after surgery, anthropometric, body composition, biochemical parameters, fasting plasma glucagon, ghrelin, and PYY as well a...
Source: Obesity Surgery - Category: Surgery Source Type: research
Conclusion Taken together, evidence from animal and human studies demonstrates that the brain detects levels of circulating nutrients and hormones and consequently organizes an outward response that contributes to the regulation of whole-body glucose homeostasis. However, there are major knowledge gaps about the exact nature of this response and its relative importance compared to peripheral processes. As we have seen, animal studies have provided an anatomical map of CNS glucose regulation and have identified important neurons and neural circuits involved. Additionally, the CNS sensing of key nutrients and hormones has b...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
Alyce M. Martin1, Emily W. Sun1, Geraint B. Rogers2,3 and Damien J. Keating1,4* 1Molecular and Cellular Physiology Laboratory, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia 2Microbiome Research Laboratory, Flinders University, Adelaide, SA, Australia 3Infection and Immunity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia 4Nutrition and Metabolism, South Australian Health and Medical Research Institute, Adelaide, SA, Australia The microbial community of the gut conveys significant benefits to host physiology. A clear relationship has now bee...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
Conclusions: Bariatric surgery appears to be capable of partially reversing the obesity-related epigenome. The identification of potential epigenetic biomarkers predictive for the success of bariatric surgery may open new doors to personalized therapy for severe obesity. Introduction Obesity is currently a huge healthcare problem, worldwide, and is a risk factor for several diseases such as type 2 diabetes (T2D), cardiovascular disease and cancer (1). As the prevalence of obesity reaches pandemic proportions, this metabolic disease is estimated to become the biggest cause of mortality in the near future (2). In fact,...
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research
Authors: Wang FG, Bai RX, Yan WM, Yan M, Dong LY, Song MM Abstract The modulation of the gut microbiota was recently deemed one of the mechanisms responsible for the excellent outcomes of bariatric surgery. However, to date, only few studies have assessed this, and they have high heterogeneity. In the present study, next-generation 16S ribosomal DNA amplicon sequencing was used to characterize the gut microbiota of healthy volunteers, as well as patients prior to and after sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Significant differences in α diversity, β diversity and species were iden...
Source: Experimental and Therapeutic Medicine - Category: General Medicine Tags: Exp Ther Med Source Type: research
AbstractPurpose of ReviewWe review current evidence regarding changes in bile acid (BA) metabolism, transport, and signaling after bariatric surgery and how these might bolster fat mass loss and energy expenditure to promote improvements in type 2 diabetes (T2D) and nonalcoholic fatty liver disease (NAFLD).Recent FindingsThe two most common bariatric techniques, Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG), increase the size and alter the composition of the circulating BA pool that may then impact energy metabolism through altered activities of BA targets in the many tissues perfused by systemic bl...
Source: Current Obesity Reports - Category: Eating Disorders & Weight Management Source Type: research
ConclusionSynchronous VHR and BS in a bariatric unit is feasible with low recurrence rate. Laparoscopic VHR has lower complication rates than open, apart from seroma formation. Patients with diabetes have higher risk of infection.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
Abstract BACKGROUND: Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass (LRYGB) are 2 widely used procedures performed in bariatric surgery. However, their long-term weight loss effects have not been well compared. OBJECTIVES: To evaluate the long-term outcome of 2 procedures for treating morbid obesity. SETTING: The gastrointestinal surgery center, Eastern Hospital, Sichuan Academy of Medical Sciences &Sichuan Provincial People's Hospital. METHODS: Three electronic databases, PubMed, CNKI, and EMBASE, were searched ending in September 2018. Eligible studies were prospecti...
Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery - Category: Surgery Authors: Tags: Surg Obes Relat Dis Source Type: research
CONCLUSIONS: This study suggested comparable effectiveness between SG and RYGB on weight loss. (Surg Obes Relat Dis 2019;X:XXX-XXX.) © 2019 American Society for Metabolic and Bariatric Surgery. All rights reserved. PMID: 30772254 [PubMed - as supplied by publisher]
Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery - Category: Surgery Authors: Tags: Surg Obes Relat Dis Source Type: research
Abstract BACKGROUND: Mechanisms of metabolic improvement after bariatric surgery remain incompletely understood. Intestinal glucose uptake is increased after gastric bypass in rodents, potentially contributing to reduced blood glucose and type 2 diabetes remission. OBJECTIVE: We assessed whether intestinal glucose uptake is increased in humans after gastric surgery. SETTING: University Hospital, United States. METHODS: In a retrospective, case-control cohort study, positron emission tomography-computerized tomography scans performed for clinical indications were analyzed to quantify intestinal gluco...
Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery - Category: Surgery Authors: Tags: Surg Obes Relat Dis Source Type: research
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