Role of Gastrointestinal Hormones as a Predictive Factor for Long-Term Diabetes Remission: Randomized Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy, and Greater Curvature Plication.

PURPOSE: Long-term studies comparing the mechanisms of different bariatric techniques for T2DM remission are scarce. We aimed to compare type 2 diabetes (T2DM) remission after a gastric bypass with a 200-cm biliopancreatic limb (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP), and to assess if the initial secretion of gastrointestinal hormones may predict metabolic outcomes at 5 years. MATERIAL AND METHODS: Forty-five patients with mean BMI of 39.4(1.9)kg/m2 and T2DM with HbA1c of 7.7(1.9)% were randomized to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and AUC of GLP-1 after SMT were determined prior to and at months 1 and 12 after surgery. At 5-year follow-up, anthropometrical and biochemical parameters were determined. RESULTS: Total weight loss percentage (TWL%) at year 1 and GLP-1 AUC at months 1 and 12 were higher in the mRYGB than in the SG and GCP. TWL% remained greater at 5 years in mRYGB group - 27.32 (7.8) vs. SG - 18.00 (10.6) and GCP - 14.83 (7.8), p = 0.001. At 5 years, complete T2DM remission was observed in 46.7% after mRYGB vs. 20.0% after SG and 6.6% after GCP, p < 0.001. In the multivariate analysis, shorter T2DM duration (OR 0.186), p = 0.008, and the GLP-1 AUC at 1 month (OR 7.229), p = 0.023, were prognostic factors for complete T2DM remission at 5-year follow-up. CONCLUSIONS: Long-term T2DM remission is mostly achieved with hypoabsortive techniques such as mRYGB. Increased secretion of GLP-1 after surgery and shorter disease duration were the main predictors of T2DM remission at 5 years.

Guía española de práctica clínica utilización de los dispositivos de avance mandibular (DAM) en el tratamiento de pacientes adultos con síndrome de apneas-hipopneas del sueño / Spanish guide to clinical practice using mandibular advancement devices (MAD) in the treatment of adult patients with sleep apnea-hypopnea syndrome

Objetivos: La GPC se orienta a los profesionales encuadrados en unidades de sueño en el diagnóstico del SAOS y de su tratamiento, especialmente con CPAP nasal. Asimismo el presente documento aspira a ser de utilidad para las distintas especialidades involucradas en el seguimiento de pacientes con SAOS. Objetivos: - Valorar la eficacia de los dispositivos de avance mandibular en el tratamiento de los pacientes adultos con síndrome de apneas-hipopneas obstructivas del sueño (SAOS). - Valorar los factores predictores de buena respuesta al tratamiento con dispositivos de avance mandibular en pacientes adultos diagnosticados de SAOS. - Valorar la metodología de implementación y seguimiento del tratamiento con DAM en pacientes adultos diagnósticados de SAOS. Finalmente, pretende aportar información de interés para los pacientes adultos diagnosticados de SAOS.