ObjectiveTo investigate the effect and mechanism of sleeve gastrectomy (SG) on reducing blood glucose level. MethodsThirty GK rats were randomly divided into SG group, sham operation (SO) group, pair-fed (PF) group, and blank control (BC) group. The changes of weight, fasting blood glucose, glucose tolerance (oral glucose tolerance test, OGTT), insulin tolerance (insulin tolerance test, ITT), plasma insulin, ghrelin, and glucagon like peptide-1 (GLP-1) were monitored before and 24 weeks after operation respectively. ResultsFrom the 4th week after operation, weight gain in SG group and PF group began to decrease significantly compared with SO group (Plt;0.01). From the 2nd week after operation, fasting blood glucose level in SG group was lower than that in SO, PF, and BC groups (Plt;005), and the glucose tolerance in SG group obviously improved compared with preoperation and the other 3 groups (Plt;0.01). On the 6th week after operation, the insulin sensitivity in SG group obviously improved compared with SO group (Plt;0.05, Plt;0.01). There was no significant difference of insulin level between SG group and SO group (Pgt;0.05), ghrelin level significantly decreased (Plt;0.01) while GLP-1 level significantly increased (Plt;0.01) in SG group compared with SO group during 2-24 weeks after operation. ConclusionsThe effect of SG on reducing blood glucose is definite. SG can directly lower blood glucose independent with weight loss. Postoperative decreased ghrelin level and increased GLP-1 level may be its primary mechanism.
Diabetic retinopathy (DR) is one of the most serious complications of diabetes mellitus. Severe diabetic macular edema or proliferative retinopathy may lead to impaired vision or even blindness in diabetic patients. The glucagon-like peptide-1 receptor agonist (GLP-1RA) is now commonly used as novel glucose-lowering agents in the clinical management of type 2 diabetes, but the rapid glycaemic changes associated with the use of the GLP-1RA may aggravate the risk of an increase in the occurrence of short-term potential DR. Potential effects and mechanisms of DR include oxidative stress, vascular endothelial growth factor, inflammation, retinal neurodegeneration, and other cytokines.Whether GLP-1RA leads to the increased risk of DR remains controversial. More basic and clinical studies are needed with the aim of further clarifying the correlation between GLP-1RA and DR risk.
ObjectiveTo investigate the effect and mechanism of gastric bypass surgery (GBP) on fasting bloo-glucose (FBG) in type 2 diabetic rats. MethodsThe models of type 2 diabetic rats were induced by stretozotocin and 20 diabetic rats were randomly divided into two groups: diabetes-operation group (DO group, n=10) and diabetes-control group (DC group, n=10). Another twenty normal rats were randomly divided into two groups: normaloperation group (NO group, n=10) and normal-control group (NC group, n=10). The rats underwent GBP in DO group and NO group and sham operation in DC group and NC group. The FBG levels, serum dipeptidyl peptidase Ⅳ (DPPⅣ), and glucagon-like peptide-1 (GLP-1) concentrations of rats in each group were detected before operation and at 72 h, on 1 week, 4 weeks, and 8 weeks after operation. ResultsThe FBG levels of rats before operation were not significantly different between DO group and DC group or between NO group and NCgroup (Pgt;0.05). After operation, the FBG levels of rats in DO group gradually declined, reached the bottom on 4 weeks after operation and rose slightly on 8 weeks; The FBG levels of rats in DO group were lower after operation than before operation (Plt;0.05); After operation the FBG levels of rats in DO group were higher than that in NO group and NC group at the same time point (Plt;0.05); In DC group, the difference of FBG levels of rats at different time point was not statistically significant (Pgt;0.05); The inter-group and intra-group difference of FPG levels of rats for NO group and NC group was not statistically significant (Pgt;0.05). The concentrations of serum DPP-Ⅳ of rats before operation were not significantly different in each group (Pgt;0.05). After operation, the concentrations of serum DPP-Ⅳ of rats in DO group and NO group gradually decreased and markedly lower than that before operation, respectively (Plt;0.05). The concentrations of serum DPP-Ⅳ of rats after operation in DO group and NO group were significantly lower than that at the same time point in DC group and NC group, respectively (Plt;0.05); The intragroup difference of serum DPP-Ⅳ concentrations of rats for DC group and NC group was not statistically significant (Pgt;0.05). The concentrations of serum GLP-1 of rats before operation were not significantly different between DO group and DC group or between NO group and NC group (Pgt;0.05). After operation, the concentrations of serum GLP-1 of rats in DO group and NO group gradually increased, reached the top on 4 weeks after operation and declined slightly on 8 weeks; The concentrations of serum GLP-1 of rats in DO group and NO group were higher after operation than before operation (Plt;0.05);After operation, the concentrations of serum GLP-1 of rats in NO group were higher than that in NC group (Plt;0.05), but the concentrations of serum GLP-1 of rats at different time point in NO group were not different (Pgt;0.05). The intragroup difference of serum GLP-1 concentrations of rats for DC group and NC group was not statistically significant (Pgt;0.05). ConclusionsThere is obvious hypoglycemic effect of GBP on FBG levels of type 2 diabetic rats other than normal rats, in which high secretion of GLP-1 and low secretion of DPP-Ⅳ may be play an important role.
ObjectiveTo explore a surgery of effective weight loss concentrating on gut hormone release. MethodsWistar rats were fed with high-fat diet for inducing obesity and which randomly divided into sleeve gastrectomy plus decent jejunoileal bypass (SJB) group (n=12), sleeve gastrectomy (SG) group (n=12), and sham operation (SO) group (n=11), the body weight reduction, food intake, plasma ghrelin level, and glucagon like peptide-1 (GLP-1) level were compared among three groups. ResultsThere were no differences of the body weight and food intake before operation among three groups (Pgt;0.05). Compared with the SO group, the body weight descended and the food intake decreased obviously on 1-8 weeks after operation in the SJB group (Plt;0.05), the body weight of rats on 1-8 weeks after operation in the SJB group significantly descended as compared with the SG group (Plt;0.05), and the food intake of rats on week 3, 6, 7, and 8 in the SJB group signicantly decreased as compared with the SG group (Plt;0.05). There were no differences of the levels of the plasma ghrelin and GLP-1 before operation among three groups (Pgt;0.05). Compared with SO group, the plasma ghrelin level decreased and the GLP-1 level increased in the SJB group and the SG group, meanwhile the SJB group significantly decreased level of plasma ghrelin and elevated level of plasma GLP-1 as compared with the SG group on week 8 after operation(Plt;0.05). ConclusionThe data demonstrate that SJB could represent an effective way of losing weight by interfering with food intake and obesity related hormone levels.
ObjectiveTo investigate the impact of elevated fasting blood glucose (FBG) level after open radical hepatectomy on the early recurrence of hepatocellular carcinoma (HCC).MethodsThe clinical data of 112 patients with HCC who underwent the open radical hepatecomy from January 2013 to December 2014 in the Affiliated Hospital of Qingdao University were retrospectively analyzed. After the radical resection of HCC, 86 patients with level of FBG 3.9–6.1 mmol/L and 26 patients with level of FBG≥6.1 mmol/L were design into a normal FBG group and an elevated FBG group, respectively. The recurrence rates of HCC were compared between the two groups at 1- and 2-year after the opreation.ResultsThere were no significant differences between the 2 groups in the gender, age, history of alcohol drinking, hepatitis B history, preoperative ALT, AST, AFP and Child-Pugh classification, scope of hepatectomy, intraoperative hemorrhage, hepatic blood flow occlusion, diameter of maximal tumor, histopathological differentiation, tumor number, cirrhosis, satellite lesion, postoperative adjuvant TACE treatment or not (P>0.05). The postoperative 1- and 2-year recurrence rates of HCC were 19.8% (17/86) and 33.7% (29/86) in the normal FBG group and 42.3% (11/26) and 61.5% (16/26) in the elevated FBG group, respectively, showing significant differences between the 2 groups (P<0.05). The results of multivariate analysis showed that the level of FBG≥6.1 mmol/L, low histopathological differentiation, and no postoperative TACE treatment were the independent risk factors affecting tumor-free survival rate after the open radical resection of HCC (P<0.05). ConclusionsElevated FBG level after open radical resection has a stimulative effect on early recurrence of HCC. As a result, monitoring and controlling of FBG level after operation is helpful in decreasing early recurrence rate of patients with HCC.
ObjectiveTo investigate the association between the stress-induced hyperglycemia ratio (SHR) and all-cause, cardiovascular, and diabetes-related mortality in patients with advanced cardiovascular-kidney-metabolic (CKM) syndrome, and to evaluate the value of SHR as an independent prognostic marker. MethodsThis retrospective cohort study used data from the 1999–2018 U.S. National Health and Nutrition Examination Survey (NHANES). A total of 2 135 patients with advanced CKM (stages 3 and 4) were included. Kaplan-Meier analysis and multivariable Cox regression models were applied to assess the relationship between SHR and mortality outcomes. Restricted cubic spline (RCS) analysis was employed to explore potential non-linear associations. Subgroup analyses were conducted to identify possible effect modifiers. ResultsOver a mean follow-up of 248 months, 674 all-cause, 198 cardiovascular, and 31 diabetes-related deaths occurred. Elevated SHR was significantly associated with diabetes-related mortality (HR=3.48, P<0.001) in a dose-response manner. SHR exhibited a U-shaped relationship with both all-cause and cardiovascular mortality (non-linearity P<0.001), indicating increased risk at both low and high SHR levels. Subgroup analyses revealed that sex, BMI, and hyperlipidemia significantly modified the association between SHR and diabetes-related death. ConclusionSHR is an independent predictor of mortality risk in patients with advanced CKM syndrome, particularly for diabetes-related death. These findings support the integration of SHR into risk stratification of high-risk CKM populations and provide a basis for metabolic stress-targeted interventions.
ObjectiveTo systematically evaluate the effects of weight-loss interventions on hormone levels and sexual function in patients with obesity. MethodsThis review was conducted in accordance with PRISMA guidelines. A systematic search of PubMed, Embase, and other databases was performed for studies published within the past decade that investigated the effects of bariatric surgery, glucagon-like peptide 1 (GLP-1) receptor agonists, and lifestyle interventions on sex hormones and sexual function. ResultsBariatric surgery (e.g., sleeve gastrectomy, gastric bypass) demonstrated the most pronounced improvements in hormonal balance and sexual function. In males, total testosterone levels doubled postoperatively, with marked increase in erectile function score. In females with polycystic ovary syndrome, androgen levels were reduced by 50%, with significant amelioration in the female sexual function index. GLP-1 receptor agonists (e.g., semaglutide, liraglutide) partially improved sperm quality and testosterone levels, but were also associated with a higher risk of erectile dysfunction (with a hazard ratio of approximately 4.5). Lifestyle interventions (e.g., low-calorie diet, exercise) could increase sex hormone-binding globulin levels and improve sexual function score, although their efficacy remained inferior to that of surgery. ConclusionsWeight-loss interventions can alleviate hormonal imbalances and sexual dysfunction in obesity, with bariatric surgery demonstrating the most significant effects. Pharmacological and lifestyle interventions have shown variable efficacy. Future research should further investigate mechanisms underlying effects of different weight-loss modalities on sexual health.
In July 2023, six scientific organizations, including the American Heart Association (AHA) and the American College of Cardiology (ACC), jointly released the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease. By reviewing the latest scientific data, the guideline reemphasized the importance of a healthy diet, regular physical activity and smoking cessation in cardiovascular health. Routine testing is limited to patients with changes in clinical or functional status. Regarding the clinical management of CCD, the guideline limited the use of beta-blockers (BB) and updated recommendations for the usage of three drugs, including sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 (GLP-1) receptor agonists, and bempedoic acid.
Objective To observe the feature of post-operative hyperglycemia after coronary artery bypass grafting(CABG) surgery in department of intensive care unit（ICU） patients.Methods Patients who had CABG surgery in Zhongshan Hospital from January 2005 to December 2005 were enrolled.Data were collected including the history of diabetes，pre-operative and post-operative blood glucose(BG) levels，and the time that post-operative hyperglycemia and peak BG occurred.The patients were divided into diabetic and non-diabetic groups according to the diabetic history.The data were compared and analyzed between the two groups.Results 200 patients were enrolled in this study.The incidence of post-operative hyperglycemia was 77%，and about 99.4% occurred in the first 24 hours admitted to ICU，which was independent on diabetic history (χ2=2.58，P=0.108)，but was related to the BG level above 6.1 mmol/L (χ2=12.31，P=0.000).In 80% of the patients，peak BG occurred in the first 24 hours admitted to ICU，which was significantly earlier in the non-diabetic group compared with the diabetic group (8.5 h vs 18.5 h，P=0.02 ).In the patients who had post-operative hyperglycemia，the median time of the BG peak is 10 hours，and 75.3% of the BG peak occurred in the first 24 hours admitted to ICU.Conclusion There is a high incidence of post-operative hyperglycemia in post-CABG patients which always occur within 24 hours after operation and relate to pre-operative high BG.