Association between the preoperative fasting and postprandial C-peptide AUC with resolution of type 2 diabetes 6 months following bariatric surgery

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• 作者：Akhila Mallipedhi^a ; ^b ; ^{mallipedhi@doctors.org.uk" class="auth_mail" title="E-mail the corresponding author} ; Thinzar Min^a ; ^b ; Sarah L. Prior^a ; Claire MacIver^b ; Steve D. Luzio^a ; Gareth Dunseath^a ; Richard M. Bracken^a ; Saiful Islam^c ; Jonathan D. Barry^d ; Scott Caplin^d ; Jeffrey W. Stephens^a ; ^b ; ^d
• 关键词：T2DM ; Type 2 diabetes mellitus ; %EWL ; Percentage of excess weight loss ; HbA1c ; Glycated hemoglobin ; OGTT ; Oral glucose tolerance test- ; GLP-1 ; Glucagon-like peptide-1 ; IFG ; Impaired fasting glycemia ; IGT ; Impaired glucose tolerance ; BMI ; Body mass index ; BPD ; Bilio-pancreatic diversion ; LSG ; Laparoscopic sleeve gastrectomy ; LAGB ; Laparoscopic adjustable gastric band ; RYGB ; Roux-en-Y gastric bypass ; LDL-C ; Low density lipoprotein-cholesterol ; HDL-C ; High density lipoprotein-cholesterol ; HOMA ; Hom
• 刊名：Metabolism
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：64
• 期：11
• 页码：1556-1563
• 全文大小：456 K

文摘

Bariatric surgery results in the remission of type 2 diabetes mellitus (T2DM) in morbidly obese subjects. The aim of the study was to investigate the predictive value of both static and dynamic measures of C-peptide in relation to T2DM resolution 6 months after bariatric surgery regardless of the operation type.

Methods and Results

A non-randomized prospective study of 24 participants with T2DM undergoing bariatric surgery. Measurements of fasting and 2-hour plasma glucose, insulin, C-peptide and measures of insulin sensitivity were recorded temporally during an oral glucose tolerance test pre-operatively and 6 months post-operatively. A responder was defined with a fasting glucose < 5.6 mmol/L and HbA_1c < 6.0% postoperatively. Within the sample there were 11 responders and 13 non-responders at 6 months. There was a significant difference in the duration of diabetes between the groups. Fasting C-peptide (P ≤ 0.05) and 2-hour C-peptide (P ≤ 0.05) were higher in responders compared to non-responders. Significantly higher C-peptide levels were observed preoperatively at all time points for responders, with significantly higher area under the curve (AUC_0–60 and AUC_0–120). Using the lower quartiles for C-peptide levels, both fasting C-peptide (> 2.5 ng/mL [0.83 nmol/L]) and 2-hour C-peptide (> 5.2 ng/mL [1.73 nmol/L]) had a sensitivity and negative predictive value of 100% to predict T2DM remission. Logistic regression showed that C-peptide, duration of diabetes and BMI were associated with response. The area under the ROC curve was 0.94 and a regression model predicted diabetes remission with a sensitivity of 85.7% and a specificity of 88.9%.

Conclusions

This study demonstrated that static (fasting) and dynamic (AUC, 2-hour) C-peptide measurements predict T2DM resolution 6 months following bariatric surgery. This work provides insight into C-peptide dynamics as a predictor of response to bariatric surgery.