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Urinary Albumin Excretion, HMW Adiponectin, and Insulin Sensitivity in Type 2 Diabetic Patients Undergoing Bariatric Surgery

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

RYGB:

Roux-en-Y gastric bypass

GR:

gastric restriction

UACR:

urine albumin creatinine ratio

T2DM:

type 2 diabetes

CKD:

chronic kidney disease

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Acknowledgements

We are grateful to the skilled assistance of the nurses and technicians in the Cleveland Clinic, Clinical Research Unit. This work was supported in part by National Institutes of Health, National Center for Research Resources [NCRR], Multidisciplinary Clinical Research Career Development Programs Grant 5K12RR023264 (SRK), National Institutes of Aging Award RO1 AG12834 (JPK), National Center for Research Resources, CTSA 1UL1RR024989, Ethicon Endo-Surgery (PRS, SRK), and by Department of Nephrology and Hypertension, Cleveland Clinic (SDN).

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Authors and Affiliations

  1. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q7, Cleveland, OH, 44195, USA

    Sankar D. Navaneethan

  2. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    Karen R. Kelly & John P. Kirwan

  3. Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA

    Firas Sabbagh & Philip R. Schauer

  4. Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA

    John P. Kirwan

  5. Department of Endocrinology, Cleveland Clinic, 9500 Euclid Avenue, A51, Cleveland, OH, USA

    Sangeeta R. Kashyap

Authors
  1. Sankar D. Navaneethan
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  2. Karen R. Kelly
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  3. Firas Sabbagh
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  4. Philip R. Schauer
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  5. John P. Kirwan
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  6. Sangeeta R. Kashyap
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Corresponding author

Correspondence to Sangeeta R. Kashyap.

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Navaneethan, S.D., Kelly, K.R., Sabbagh, F. et al. Urinary Albumin Excretion, HMW Adiponectin, and Insulin Sensitivity in Type 2 Diabetic Patients Undergoing Bariatric Surgery. OBES SURG 20, 308–315 (2010). https://doi.org/10.1007/s11695-009-0026-1

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  • DOI: https://doi.org/10.1007/s11695-009-0026-1

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