Bariatric Times - January 2009 - (Page 23)

Bariatric Times • January 2009 Metabolic Perspective 23 hypoglycemia should turn out to be a frequent complication of either bypass operations or medical treatment, it might be beneficial to provide GLP-1 mimetics in courses, with time between courses to maintain normal regulatory mechanisms. Determination of optimum schedules for treatment may require a considerable effort and lengthy studies. Metabolic obesity surgeons and endocrinologists could benefit their patients by increasing collaboration in such clinical research.22 There is also an urgent need to reduce the overall cost of treatment of obesity and its complications, as the prevalence continues to rise. We need treatment for obesity now in 100 million people in the United States, and the number and severity continues to rise. I have suggested to pharmacists that they provide us with coated sugar that would be released in the ileum. This might take the place of bypass operations for many of the patients with BMI s greater than or equal to 30. Prevention of obesity remains the most important goal. Humans need to return to a more physical and less sugarcoated lifestyle. 14. 15. 16. 17. 18. Buchwald H. Hyperinsulinemic hypoglycemia developing late after gastric bypass. Obes Surg. 2007;17:592–594. Holst JJ. The physiology of glucagon-like peptide 1. Physiol Rev. 2007;87:1409–1439. Kieffer TJ, Habener JF. The glucagon-like peptides. Endocrine Rev. 1999;20:876–913. Pories WJ, Albrecht RJ. Etiology of type II diabetes: role of the foregut. World J Surg. 2001;25:527–531. Mason EE. Ileal transposition and enteroglucagon/GLP-1 in obesity (and diabetic?) surgery. Obes Surg. 1999;9:223–228. Strader AD, Vahl TP, Jandacek RJ, et al. Weight loss through ileal transposition is accompanied by increased ileal hormone secretion and synthesis in rats. Am J 19. 20. 21. 22. Physiol Endocrinol Metab. 2004;288:E447–E453. Rodriguez-Grunert L, Neto MPG, Alamo M, et al. First human experience with delivered and retrieved duodenal-jejunal bypass sleeve. SOARD. 2008;4:55–559. The Tantalus System. www.metacure.com. Accessed November 2, 2008. Mason E. Development and future of gastroplasties for morbid obesity. Arch Surg. 2003;138:361–366. Mason E, Jamal MK, O’Dorisio TM. The surgical approach to morbid obesity. In: Donohoue PA, eds. Energy Metabolism and Obesity: Research and Clinical Applications. Humana Press; Totowa (New Jersey):2008;269–296. AUTHOR CORRESPONDENCE Dr. Mason is from The Roy J. and Lucille A. Carver College of Medicine, Department of Surgery; The University of Iowa, Department of Surgery, 4125 Westlawn, Iowa City, Iowa 52242-1178. Email: edward-mason@uiowa.edu. REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Vonk FJ, Admiraal JF, Jackson Kate, et al. Evolutionary origin and development of snake fangs. Nature. 2008;454:630–633. Brener W, Hendrix TR, McHugh PR. Regulation of the gastric emptying of glucose. Gastroenterology. 1983;85:76–82. Massimino SP, McBurney MI, Field CJ, et al. Fermentable dietary fiber increases GLP-1 secretion and improves glucose homeostasis despite increased intestinal glucose transport capacity in healthy dogs. J Nutrition. 1998;128:1786–1793. Ritzel U, Fromme A, Ottleben M, et al. Release of glucagon-like peptide-1 (GLP-1) by carbohydrates in the perfused rat ileum. Acta Diabetol. 1997;34:18–21. Näslund E, Backman L, Holst JJ, et al. Importance of small bowel peptides for the improved glucose metabolism 20 years after jejunoileal bypass for obesity. Obes Surg. 1998; 8:253–260. Dennis C. Personal communication. 1945. William F. Magie (1858-1943). Princeton professor of physics, developed fluoroscopy in 1886, the year after Roentgen discovered X-rays. Schirra J, Katschinski M, Weidmann C, et al. Gastric emptying and release of incretin hormones after glucose ingestion in humans. J Clin Invest. 1996;97:92–103. Vilsboll T, et al, Holst JJ. Incretin secretion in relation to meal size. J Clin Endocrinol Metab. 2003;88:2706–2713. Valverde I, Puente J, Martin-Duce A, et al. Changes in glucagon-like peptide-1 (GLP1) secretion after biliopancreatic diversion or vertical banded gastroplasty in obese subjects. Obes Surg. 2005;15:387–397. Service GJ, Thompson GB, Service J, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric bypass surgery. New Engl J Med. 2005;353:249–254. Patti ME, McMahon G, Mun EC, et al Severe hypoglycemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia. Diabetologia. 2005;48:2236–2240. Alvarez GC, Faria EN, Beck M, et al. Laparoscopic spleen-preserving distal pancreatectomy as treatment for nesidioblastosis after gastric bypass surgery. Obes Surg. 2007;17:550–552. Bantle JP, Ikamuddin S, Kellogg TA, http://www.metacure.com http://www.obesityeducation.com/ICSSG http://www.obesityeducation.com/ICSSG

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Bariatric Times - January 2009

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