Top

Obesity Surgery

Published in:

01-07-2018 | Original Contributions

The Predictive Factors for Diabetic Remission in Chinese Patients with BMI > 30 kg/m² and BMI < 30 kg/m² Are Different

Authors: Hui Liang, Qing Cao, Huan Liu, Wei Guan, Claudia Wong, Daniel Tong

Published in: Obesity Surgery | Issue 7/2018

Abstract

Introduction

Roux-en-Y gastric bypass has been proven to be beneficial for patients with obesity and type 2 diabetes mellitus (T2DM). In less-obese patient (BMI 30–35 kg/m²), surgical treatment is indicated when medication fails to control the T2DM. Asian develops diabetes at a lower BMI. For lower-BMI patients, the rate of diabetes amelioration varies significantly with patients of higher BMI after surgical treatment. The factors that contribute to the post-operative diabetes response rate in lower-BMI patients have not been elucidated.

Methods

Between 2010 and 2014, a total of 144 patients who underwent gastric bypass for the treatment of T2DM were included for study. Patients were divided into two groups for subgroup analysis, namely BMI > 30 kg/m² and BMI < 30 kg/m². Factors affecting the remission rate were examined.

Results

Of the studied patients, the DM remission rate for the high-BMI group (BMI > 30 kg/m²) was 80% (n = 90) whereas for the lower BMI (BMI < 30 kg/m²) was 50% (n = 54), p < 0.001. For high-BMI group, low HbA1c and high fasting C-peptide are predictive factors whereas for lower-BMI group, along with elevated C-peptide level, disease duration is the positive predictive factor for DM remission.

Conclusion

Patients with BMI > 30 kg/m² and those with BMI < 30 kg/m² have distinct remission predicting factors. Low HbA1c is a predictor of remission in low-high-BMI patients while duration of diabetes is for high-low-BMI patients. C-peptide is a predictor of remission in both groups. Further large-scale studies are required to define the predictors of diabetes remission after gastric bypass in low- and high-BMI patients.

Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76. https://doi.org/10.1056/NEJMoa1200225.CrossRefPubMedPubMedCentral

Rubino F, Nathan DM, Eckel RH, et al. Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by International Diabetes Organizations. Diabetes Care. 2016;39(6):861–77. https://doi.org/10.2337/dc16-0236.CrossRef

Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Surg Obes Relat Dis. 2011;7(4):433–47. https://doi.org/10.1016/j.soard.2011.05.013.CrossRefPubMed

Lee WJ, Hur KY, Lakadawala M, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9(3):379–84. https://doi.org/10.1016/j.soard.2012.07.015.CrossRefPubMed

Ramos-Levi AM, Matia P, Cabrerizo L, et al. C-peptide levels predict type 2 diabetes remission after bariatric surgery. Nutr Hosp. 2013;28(5):1599–603. https://doi.org/10.3305/nh.2013.28.5.6554.CrossRefPubMed

Lee WJ, Lee KT, Kasama K, et al. Laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG): short-term result and comparison with gastric bypass. Obes Surg. 2014;24(1):109–13. https://doi.org/10.1007/s11695-013-1067-z.CrossRefPubMed

Wang GF, Yan YX, Xu N, et al. Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis. Obes Surg. 2015;25(2):199–208. https://doi.org/10.1007/s11695-014-1391-y.CrossRefPubMed

Scopinaro N, Adami GF, Papadia FS, et al. Effects of gastric bypass on type 2 diabetes in patients with BMI 30 to 35. Obes Surg. 2014;24(7):1036–43. https://doi.org/10.1007/s11695-014-1206-1.CrossRefPubMed

Lee WJ, Almulaifi A, Chong K, et al. The effect and predictive score of gastric bypass and sleeve gastrectomy on type 2 diabetes mellitus patients with BMI < 30 kg/m(2). Obes Surg. 2015;25(10):1772–8. https://doi.org/10.1007/s11695-015-1603-0.CrossRefPubMed

10.

Ugale S, Gupta N, Modi KD, et al. Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes—a retrospective cohort study. J Diabetes Metab Disord. 2014;13(1):89. https://doi.org/10.1186/s40200-014-0089-y.CrossRefPubMedPubMedCentral

11.

Cho MJ, Kim MS, Kim CJ, et al. Fasting serum C-peptide is useful for initial classification of diabetes mellitus in children and adolescents. Ann Pediatr Endocrinol Metab. 2014;19(2):80–5. https://doi.org/10.6065/apem.2014.19.2.80.CrossRefPubMedPubMedCentral

12.

Lachin JM, McGee P, Palmer JP, et al. Impact of C-peptide preservation on metabolic and clinical outcomes in the Diabetes Control and Complications Trial. Diabetes. 2014;63(2):739–48. https://doi.org/10.2337/db13-0881.CrossRefPubMedPubMedCentral

13.

Saisho Y. Postprandial C-peptide to glucose ratio as a marker of beta cell function: implication for the management of type 2 diabetes. Int J Mol Sci. 2016;17(5):17(5). https://doi.org/10.3390/ijms17050744.CrossRef

14.

Lee EY, Hwang S, Lee SH, et al. Postprandial C-peptide to glucose ratio as a predictor of beta-cell function and its usefulness for staged management of type 2 diabetes. J Diabetes Investig. 2014;5(5):517–24. https://doi.org/10.1111/jdi.12187.CrossRefPubMedPubMedCentral

15.

Ohkura T, Shiochi H, Fujioka Y, et al. 20/(fasting C-peptide x fasting plasma glucose) is a simple and effective index of insulin resistance in patients with type 2 diabetes mellitus: a preliminary report. Cardiovasc Diabetol. 2013;12(1):21. https://doi.org/10.1186/1475-2840-12-21.CrossRefPubMedPubMedCentral

16.

Okuno Y, Komada H, Sakaguchi K, et al. Postprandial serum C-peptide to plasma glucose concentration ratio correlates with oral glucose tolerance test- and glucose clamp-based disposition indexes. Metabolism. 2013;62(10):1470–6. https://doi.org/10.1016/j.metabol.2013.05.022.CrossRefPubMed

17.

Aminian A, Brethauer SA, Daigle CR, et al. Outcomes of bariatric surgery in type 2 diabetic patients with diminished pancreatic secretory reserve. Acta Diabetol. 2014;51(6):1077–9. https://doi.org/10.1007/s00592-014-0642-7.CrossRefPubMed

18.

Aarts EO, Janssen J, Janssen IM, et al. Preoperative fasting plasma C-peptide level may help to predict diabetes outcome after gastric bypass surgery. Obes Surg. 2013;23(7):867–73. https://doi.org/10.1007/s11695-013-0872-8.CrossRefPubMed

19.

Cohen RV, Petry TZ, Caravatto PP. Low levels of C-peptide may not be a sign of pancreatic beta-cell death or apoptosis: new insight into pancreatic endocrine function and indications for metabolic surgery. Surg Obes Relat Dis. 2013;9(6):1022–4. https://doi.org/10.1016/j.soard.2013.08.004.CrossRefPubMed

20.

Gjesing AP, Ribel-Madsen R, Harder MN, et al. Genetic and phenotypic correlations between surrogate measures of insulin release obtained from OGTT data. Diabetologia. 2015;58(5):1006–12. https://doi.org/10.1007/s00125-015-3516-9.CrossRefPubMed

21.

Chiu KC, Cohan P, Lee NP, et al. Insulin sensitivity differs among ethnic groups with a compensatory response in beta-cell function. Diabetes Care. 2000;23(9):1353–8. https://doi.org/10.2337/diacare.23.9.1353.CrossRefPubMed

22.

Ma RC, Chan JC. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci. 2013;1281(1):64–91. https://doi.org/10.1111/nyas.12098.CrossRefPubMedPubMedCentral

23.

Li Y, Meng L, Miao Q, et al. Association between physical activity and serum C-peptide levels among the elderly. Geriatr Gerontol Int. 2014;14(3):647–53. https://doi.org/10.1111/ggi.12152.CrossRefPubMed

24.

Lee WJ, Chong K, Ser KH, et al. C-peptide predicts the remission of type 2 diabetes after bariatric surgery. Obes Surg. 2012;22(2):293–8. https://doi.org/10.1007/s11695-011-0565-0.CrossRefPubMed

25.

Li Y, Zheng LS, Li Y, et al. Independent association between serum C-peptide levels and fat mass-to-lean mass ratio in the aging process. Geriatr Gerontol Int. 2015;15(7):918–26. https://doi.org/10.1111/ggi.12366.CrossRefPubMed

26.

Dixon JB, Chuang LM, Chong K, et al. Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes. Diabetes Care. 2013;36(1):20–6. https://doi.org/10.2337/dc12-0779.CrossRefPubMed

Title: The Predictive Factors for Diabetic Remission in Chinese Patients with BMI > 30 kg/m2 and BMI < 30 kg/m2 Are Different
Authors: Hui Liang
Qing Cao
Huan Liu
Wei Guan
Claudia Wong
Daniel Tong
Publication date: 01-07-2018
Publisher: Springer US
Published in: Obesity Surgery / Issue 7/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-017-3106-7

At a glance: The STEP trials

Springer Medicine

The Predictive Factors for Diabetic Remission in Chinese Patients with BMI > 30 kg/m² and BMI < 30 kg/m² Are Different

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2018

ABSI (A Body Shape Index) and ARI (Anthropometric Risk Indicator) in Bariatric Surgery. First Application on a Bariatric Cohort and Possible Clinical Use

Liraglutide Effects on Upper Gastrointestinal Investigations: Implications Prior to Bariatric Surgery

Establishing a Reproducible Murine Animal Model of Single Anastomosis Duodenoileal Bypass with Sleeve Gastrectomy (SADl-S)

Endoscopic Sleeve Gastroplasty (ESG) Is a Reproducible and Effective Endoscopic Bariatric Therapy Suitable for Widespread Clinical Adoption: a Large, International Multicenter Study

Bidirectional Jejunojejunal Anastomosis Prevents Early Small Bowel Obstruction Due to the Kinking After Closure of the Mesenteric Defect in the Laparoscopic Roux-en-Y Gastric Bypass

Diagnosing Internal Herniation After Roux-en-Y Gastric Bypass Surgery: Literature Overview, Cadaver Study and the Added Value of 3D CT Angiography