Obesity Surgery

, Volume 20, Issue 3, pp 308–315 | Cite as

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

  • Sankar D. Navaneethan
  • Karen R. Kelly
  • Firas Sabbagh
  • Philip R. Schauer
  • John P. Kirwan
  • Sangeeta R. Kashyap
Clinical Research

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.

Keywords

Albuminuria Insulin sensitivity Adiponectin Adipokines Obesity Type 2 diabetes Gastric bypass surgery Bariatric surgery 

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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Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Sankar D. Navaneethan
    • 1
  • Karen R. Kelly
    • 2
  • Firas Sabbagh
    • 3
  • Philip R. Schauer
    • 3
  • John P. Kirwan
    • 2
    • 4
  • Sangeeta R. Kashyap
    • 5
  1. 1.Department of Nephrology and Hypertension, Glickman Urological and Kidney InstituteCleveland ClinicClevelandUSA
  2. 2.Department of Pathobiology, Lerner Research InstituteCleveland ClinicClevelandUSA
  3. 3.Endocrinology and Metabolism InstituteCleveland ClinicClevelandUSA
  4. 4.Digestive Disease InstituteCleveland ClinicClevelandUSA
  5. 5.Department of EndocrinologyCleveland ClinicClevelandUSA

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