Preoperative Fasting Plasma C-Peptide Level May Help to Predict Diabetes Outcome After Gastric Bypass Surgery
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To evaluate whether preoperative measurement of fasting plasma C-peptide levels is useful to predict diabetes outcome after Roux-en-Y gastric bypass (RYGB) surgery.
Materials and Methods
Diabetes outcome after RYGB was evaluated in 126 obese patients: 41 non-diabetic controls (NDC), 29 with impaired glucose tolerance (IGT) and 56 had type 2 diabetes mellitus (T2DM). Body weight, fasting plasma glucose, fasting C-peptide levels, and HbA1c were measured at baseline and 3.6 ± 0.16 years after GBS. Complete resolution of diabetes was defined as: fasting glucose <7.0 mmol/l, HbA1c <6.5 %, achieved without anti-diabetic medication.
Patients with complete resolution of diabetes had a more recent diagnosis of T2DM, lower preoperative HbA1c levels and lower daily doses of metformin and insulin use. These parameters were related to postoperative HbA1c levels but they failed to mark the specific patients who had not reached complete resolution of T2DM. Fasting preoperative C-peptide levels had better predictive power: 90 % of T2DM patients with preoperative fasting C-peptide levels >1.0 nmol/l achieved a postoperative HbA1c <6.5 %, and 74 % achieved complete resolution of their diabetes. In contrast, none of the T2DM patients with a preoperative fasting C-peptide <1.0 nmol/l attained these goals.
A preoperative fasting plasma C-peptide level <1.0 nmol/l in severely obese T2DM patients indicates partial β-cell failure, and is associated with a markedly reduced chance of complete resolution of T2DM after RYGB. We therefore advocate measuring C-peptide levels in all diabetic patients up for bariatric surgery to improve the prediction of outcome.
- Bult, MJF (2008) Surgical treatment of obesity. European Journal of Endocrinology 158: pp. 135-145 CrossRef
- Levy, P, Fried, M (2007) The comparative effects of bariatric surgery on weight and type 2 diabetes. Obes Surg 17: pp. 1248-56 CrossRef
- Buchwald, H, Estok, R (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122: pp. 248-256 e5 CrossRef
- Vetter ML, Cardillo S et al. Narrative review: effect of bariatric surgery on type 2 diabetes mellitus, Ann Intern Med 2009; 20;150(2):94–103.
- Wahren, J, Ekberg, K, Jornvall, H (2007) C-peptide is a bioactive peptide. Diabetologica 50: pp. 5003-9 CrossRef
- Hills, CE, Brunskill, NJ (2009) Cellular and physiological effects of C-peptide. Cli Sci 116: pp. 565-574 CrossRef
- Luppi, P, Cifarelli, V, Wahren, J (2011) C-peptide and long term complications of diabetes. Pediatr Diabetes 12: pp. 276-92 CrossRef
- Pories, WJ (1995) Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222: pp. 339-350 CrossRef
- Colquitt, JL, Picot, J (2009) Surgery for obesity. Cochrane Database Syst Rev 2: pp. CD003641
- Schauer, PR, Burguera, B, Ikramuddin, S, Cottam, D, Gourash, W, Hama, G (2003) Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg 238: pp. 467-84
- Sugerman, HJ, Wolfe, LG, Sica, DA, Clore, JN (2003) Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg 237: pp. 751-6
- Brandenburg D. History and diagnostic significance of C-peptide. Exp Diabetes Res 2008: 576862.
- Thaler, JP, Cummings, DE (2009) Minireview: hormonal and metabolic mechanisms of Diabetes remission after Gastrointestinal Surgery. Endocrinology 150: pp. 2518-2525 CrossRef
- Gastrointestinal Surgery for Severe Obesity National Institutes of Health: Consensus Development Conference Statement, March 25–27, 1991.
- Sturm, R (2003) Increases in clinically severe obesity in the United States. Arch intern med 163: pp. 2146-8 CrossRef
- Bose, M (2009) Do incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: what are the evidence. Obes Surg 19: pp. 217-29 CrossRef
- Sjostrom, L, Lindroos, AK, Peltonen, M (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Eng J Med 351: pp. 2683-93 CrossRef
- Buchwald, H, Avidor, Y, Braunwald, E (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292: pp. 1724-1737 CrossRef
- Keating, CL, Dixon, JB, Moodie, ML (2009) Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care 32: pp. 580-4 CrossRef
- Preoperative Fasting Plasma C-Peptide Level May Help to Predict Diabetes Outcome After Gastric Bypass Surgery
Volume 23, Issue 7 , pp 867-873
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- Roux-en-Y gastric bypass
- Type 2 diabetes mellitus
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- Author Affiliations
- 1. Department of Surgery, Rijnstate Hospital, Internal Post 1190, PO Box 9555, 6800, TA, Arnhem, The Netherlands
- 2. Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, The Netherlands
- 3. Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands