Gastrična stimulacija u terapiji dijabetesa tip 2: rezultat posle 16. nedelje od implantacije pejsmejkera
Sažetak
Uvod/Cilj. Stimulacija želuca [gastric contraction modulation (GCM)] implantiranim sistemom DIAMOND poboljšava glikomijsku kontrolu i smanjenje telesne mase. Primarni cilj studije bio je da se proceni inicijalna efikasnost stimulacije želuca upotrebom DIAMOND sistema (ranije poznatog kao TANTALUS) u cilju poboljšanja glikoregulacije merene promenom nivoa glikoziliranih hemoglobina (HbA1c). Sekundarni ciljevi bili su analiza sniženja telesne mase, indeksa telesne mase (BMI), obima struka i drugih metaboličkih parametara. Metode. U Odeljenju za minimalno invazivnu hirurgiju gornjeg digestivnog trakta Klinike za digestivnu hirurgiju u Beogradu, u periodu između novembra 2014. godine i marta 2016. godine, kod 18 bolesnika sa dijabetesom tipa 2, laparoskopski je postavljen gastrični pejsmejker (DIAMOND sistem). Od ukupnog broja bolesnika, 11 bolesnika je bilo praćeno najmanje 16 nedelja posle operacije i uključeno u prospektivnu kohortnu studiju. Rezultati. U toku perioda praćenja, prosečan gubitak telesne mase iznosio je 8.05 kg (p < 0.05). Prosečna razlika između inicijalne vrednosti glikemije i glikemije posle 16 nedelja od implantacije pejsmejkera iznosila je 2.56 mmol/L. Sličan rezultat dobijen je prilikom procene vrednosti insulina natašte; prosečno smanjenje vrednosti posle 16 nedelja iznosilo je 6.44 m/U/L. Kod većine bolesnika konstatovano je i smanjenje vrednosti HbA1c: kod 4 bolesnika veće od 2% i kod 4 osobe do 2% (prosečno 1.19%, p < 0.05). Niži nivo insulina natašte i istovremeno smanjenje visine glikemije natašte ukazalo je na poboljšanje insulinske senzitivnosti posle 16 nedelja od implantacije pejsmejkera [homeostatic model assessment of insulin resistance (HOMA IR) prosek 5.25]. Zaključak. Stimulacija želuca DIAMOND sistemom tokom 16 nedelja od implantacije, prouzrokuje statistički značajno poboljšanje glikoregulacije i insulinske rezistencije. Dodatan pozitivan terapijski efekat odnosi se na smanjenje telesne mase, BMI i smanjenje obima struka kao glavnog parametra metaboličkog sindroma.
Reference
References
World Health Organization.Global status report on noncommu-nicable diseases. Geneva: World Health Organization; 2014.
Department of Health and Human Services, Centers for Dis-ease Control and Prevention, National Center for Health Sta-tistics. Atlanta, Health United States, with chartbook on trends of in the health of Americans; 2003.
Sugerman HJ, Wolfe LG, Sica DA, Clore JN. Diabetes and hyper-tension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg 2003; 237(6): 751−6; discussion 757−8.
Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care 2002; 25(2): 358−63.
Bohdjalian A, Prager G, Rosak C, Weiner R, Jung R, Schramm M, et al. Improvement in glycemic control in morbidly obese type 2 diabetic subjects by gastric stimulation. Obes Surg 2009; 19(9): 1221–7.
Sanmiguel CP, Conklin JL, Cunneen SA, Barnett P, Phillips EH, Kipnes M, et al. Gastric electrical stimulation with the TAN-TALUS System in obese type 2 diabetes patients: Effect on weight and glycemic control. J Diabetes Sci Technol 2009; 3(4): 964−70.
Lebovitz HE, Ludvik B, Yaniv I, Haddad W, Schwartz T, Aviv R. Metacure Investigator Group. Fasting plasma triglycerides predict the glycaemic response to treatment of type 2 diabetes by gastric electrical stimulation. A novel lipotoxicity paradigm. Diabet Med 2013; 30(6): 687−93.
American Diabetes Association. (6) Glycemic targets. Diabetes Care 2015; 38 Suppl: S33−40.
Handgraaf HJ, Nelissen RM, Bianchi R, Meesters B, Greve JW. A gastric pacemaker in obese type 2 diabetic patients. Ned Tijdschr Geneeskd 2013; 157(0): A5929. (Dutch)
Bugajski AJ, Gil K, Ziomber A, Zurowski D, Zaraska W, Thor PJ. Effect of long-term vagal stimulation on food intake and body weight during diet induced obesity in rats. J Physiol Pharmacol 2007; 58 Suppl 1: 5−12.
Konturek PC, Konturek JW, Cześnikiewicz-Guzik M, Brzozowski T, Sito E, Konturek SJ. Neuro-hormonal control of food intake: basic mechanisms and clinical implications. J Physiol Pharmacol. 2005; 56 Suppl 6: 5−25.
Konturek SJ, Konturek JW, Pawlik T, Brzozowski T. Brain-gut axis and its role in the control of food intake. J Physiol Pharmacol 2004; 55(1 Pt 2): 137−54.
Faraj M, Havel PJ, Phelis S, Blank D, Sniderman AD, Cianflone K. Plasma acylation-stimulating protein, adiponectin, leptin and ghrelin before and after weight loss induced by gastric bypass surgery in morbidity obese subjects. J Clin Endocrinol Metab 2003; 88(4): 1594−602.
Dobak JD. Dynamic nerve stimulation for treatment of disor-ders. United States Patent and Trademark Office 2005. p. 37.
Gil K, Bugajski A, Thor P. Electrical vagus nerve stimulation decreases food consumption and weight gain in rats fed a high-fat diet. J Physiol Pharmacol 2011; 62(6): 637−46.
Bohdjalian A, Prager G, Aviv R, Policker S, Schindler K, Kretschmer S, et al. One-year experience with Tantalus: A new surgical ap-proach to treat morbid obesity. Obes Surg 2006; 16(5): 627−34.
Bertoli S, Leone A, Vignati L, Spadafranca A, Bedogni G, Vanzulli A, et al. Metabolic correlates of subcutaneous and visceral ab-dominal fat measured by ultrasonography: a comparison with waist circumference. Nutr J 2016; 15: 2.
Bohdjalian A, Ludvik B, Guerci B, Bresler L, Renard E, Nocca D, et al. Improvement in glycemic control by gastric electrical stimulation (TANTALUS) in overweight subjects with type 2 diabetes. Surg Endosc 2009; 23(9): 1955−60.
Nauck MA, Niedereichholz U, Ettler R, Holst JJ, Orskov C, Ritzel R, et al. Glucagon-like peptide 1 inhibition of gastric emptying outweighs its insulinotropic effects in healthy humans. Am J Physiol 1997; 273(5 Pt 1): E981−8.
Drucker DJ, Nauck MA. The incretin system: Glucagon-like-peptie-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet 2006; 368(9548): 1696−705.