In morbidly obese patients undergoing Roux-en-Y gastric bypass, being in the bottom tertile of baseline β-cell glucose sensitivity was the only predictor of diabetes remission failure (OR 7.9; 95% CI 1.2-51.9; P=0.03).
Cohort (n=43)
No
Does Roux-en-Y gastric bypass improve beta-cell function and induce diabetes remission in morbidly obese patients with T2DM?
In morbidly obese patients undergoing Roux-en-Y gastric bypass, baseline beta-cell glucose sensitivity is a strong predictor of type 2 diabetes remission at 1 year.
Odds Ratio: 7.9 (95% CI 1.2–51.9)
p-value: p=0.03
CONTEXT: Bariatric surgery can induce remission in a high proportion of severely obese patients with type 2 diabetes mellitus (T2DM). OBJECTIVE: Our objective was to investigate predictors and mechanisms of surgery-induced diabetes remission. PATIENTS AND SETTING: Forty-three morbidly obese subjects (body mass index = 45.6 ± 5.0 kg/m(2)), 32 with T2DM and 11 nondiabetic normal glucose tolerance (NGT), participated at a clinical research center. INTERVENTION: Patients underwent Roux-en-Y gastric bypass. MAIN OUTCOME MEASURES: Diabetes remission and β-cell function were evaluated. RESULTS: Subjects were tested before and 45 d and 1 yr after surgery. Weight decreased similarly in T2DM and NGT (-39 kg at 1 yr, P < 0.0001). Insulin sensitivity improved in both groups in proportion to the changes in body mass index but remained lower in T2DM than NGT (386 ± 91 vs. 479 ± 89 ml/min · m(2), P < 0.01). Based on glycosylated hemoglobin and oral glucose testing, diabetes had remitted in nine patients at 45 d and in an additional 16 at 1 yr. In T2DM, β-cell glucose sensitivity increased early after surgery but was no further improved and still abnormal at 1 yr median, 48 (coefficient interval, 53) pmol/min · m(2) · mm vs. median, 100 (coefficient interval, 68) of NGT, P < 0.001. Baseline β-cell glucose sensitivity was progressively worse in early remitters, late remitters, and nonremitters (median, 54coefficient interval, 50 vs. median, 22coefficient interval, 26 vs. median, 4coefficient interval, 10 pmol/min · m(2) · mm) and, by logistic regression, was the only predictor of failure odds ratio for bottom tertile = 7.9 (95% confidence interval = 1.2-51.9); P = 0.03. CONCLUSIONS: In morbid obesity, Roux-en-Y gastric bypass causes rapid and profound metabolic adaptations; insulin sensitivity improves in proportion to the weight loss, and β-cell glucose sensitivity increases independently of weight loss. Over a period of 1 yr after surgery, diabetes remission depends on the starting degree of β-cell dysfunction.
Nannipieri et al. (Thu,) conducted a cohort in Morbid obesity with and without type 2 diabetes mellitus (n=43). Bottom tertile of baseline β-cell glucose sensitivity vs. Higher tertiles of baseline β-cell glucose sensitivity was evaluated on Failure of diabetes remission at 1 year (OR 7.9, 95% CI 1.2-51.9, p=0.03). In morbidly obese patients undergoing Roux-en-Y gastric bypass, being in the bottom tertile of baseline β-cell glucose sensitivity was the only predictor of diabetes remission failure (OR 7.9; 95% CI 1.2-51.9; P=0.03).
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