Urinary Albumin Excretion, HMW Adiponectin, and Insulin Sensitivity in Type 2 Diabetic Patients Undergoing Bariatric Surgery
- Sankar D. NavaneethanAffiliated withDepartment of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic
- , Karen R. KellyAffiliated withDepartment of Pathobiology, Lerner Research Institute, Cleveland Clinic
- , Firas SabbaghAffiliated withEndocrinology and Metabolism Institute, Cleveland Clinic
- , Philip R. SchauerAffiliated withEndocrinology and Metabolism Institute, Cleveland Clinic
- , John P. KirwanAffiliated withDepartment of Pathobiology, Lerner Research Institute, Cleveland ClinicDigestive Disease Institute, Cleveland Clinic
- , Sangeeta R. KashyapAffiliated withDepartment of Endocrinology, Cleveland Clinic Email author
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Microalbuminuria portends an increased risk for renal and cardiovascular diseases in diabetes. In this pilot study, we determined the effect of weight loss induced by different types of bariatric surgery on albuminuria in severely obese type 2 diabetic (T2DM) subjects.
Fifteen consecutive T2DM patients (9M/6F, 51 ± 14 years, body mass index (BMI) 49 ± 9 kg/m2, HbA1c 7.2 ± 1.1%) undergoing either Roux-en-Y gastric bypass (RYGB; N = 9) or other types of bariatric surgery (N = 6) underwent determination of urine albumin/creatinine ratio (UACR) and adipokine and insulin sensitivity during a mixed meal tolerance test performed 2 weeks prior to and 6 months following surgery.
Following RYGB, there was a significant decrease in BMI (−4.74 ± −5.05 kg/m2), fasting glucose, cholesterol, and leptin levels. Insulin sensitivity (Matsuda index [12.05 ± 3.81, p = 0.003]) and high molecular weight (HMW) adiponectin increased significantly along with a significant reduction in UACR (median, 36 mg/g [7–94] vs. 27 mg/g [5.5–42.5], p = 0.01). The reduction in UACR following RYGB was inversely correlated with the Matsuda index (r = −0.74, p = 0.02) and HMW adiponectin (r = −0.67, p = 0.04). In contrast, despite reduction in BMI (−4.11 ± −4.10 kg/m2) following other types of bariatric surgery (n = 6), there was no significant improvement in insulin sensitivity (0.88 ± 2.40, p = 0.63), UACR, or HMW adiponectin levels.
RYGB in severely obese DM subjects is associated with a reduction in albuminuria that correlates to the improvement in insulin sensitivity and HMW adiponectin. The data point to a need for larger studies to confirm these findings and evaluate the micro–macrovascular benefits including renal parenchymal benefits of different types of bariatric surgery in T2DM.
KeywordsAlbuminuria Insulin sensitivity Adiponectin Adipokines Obesity Type 2 diabetes Gastric bypass surgery Bariatric surgery
- Urinary Albumin Excretion, HMW Adiponectin, and Insulin Sensitivity in Type 2 Diabetic Patients Undergoing Bariatric Surgery
Volume 20, Issue 3 , pp 308-315
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- Insulin sensitivity
- Type 2 diabetes
- Gastric bypass surgery
- Bariatric surgery
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- Author Affiliations
- 1. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q7, Cleveland, OH, 44195, USA
- 2. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- 3. Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA
- 4. Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
- 5. Department of Endocrinology, Cleveland Clinic, 9500 Euclid Avenue, A51, Cleveland, OH, USA