Urinary Albumin Excretion, HMW Adiponectin, and Insulin Sensitivity in Type 2 Diabetic Patients Undergoing Bariatric Surgery
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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
Roux-en-Y gastric bypass
urine albumin creatinine ratio
type 2 diabetes
chronic kidney disease
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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