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The IGF-Axis and Diabetic Retinopathy Before and After Gastric Bypass Surgery

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Abstract

Background

Laparoscopic gastric bypass (LGB) abruptly causes remission of type 2 diabetes (T2D). Such dramatic metabolic changes have previously been found to cause worsening of diabetic retinopathy (DR) and circulating insulin-like growth factor I (IGF-I) has been suggested as a causal mediator. We aimed to evaluate baseline imbalances in the circulating IGF-system and changes after LGB in patients with T2D.

Methods

Prospective ocular examinations and measurement of the IGF-axis before and 3 and 12 months after LGB. IGF-bioactivity was measured by cell-based IGF-I receptor (IGF-IR) kinase activation assay (bioactive IGF). Total IGF-I, IGF-II and IGF binding protein (IGFBP) 1 and 3 were determined by immunoassays.

Results

At baseline, 18 of 36 patients presented with DR. These patients had higher levels of bioactive IGF (p = 0.03) than patients without DR and this association was strengthened in multivariate analysis (p = 0.006). Three patients had worsening of DR, unrelated to other markers. In univariate analysis, bioactive IGF increased at 3 months (p = 0.05) but this change became insignificant in multivariate analysis (p = 0.11). IGFBP-1 increased whereas IGFBP-3 and total IGF-II decreased at the two postoperative visits (p ≤ 0.001). Total IGF-I showed no significant changes. HbA1c, glucose, HOMA-IR and lipids improved after surgery. Two patients did not complete the 12-month visit.

Conclusions

In obese T2D patients, bioactive IGF is a potential biomarker for DR and levels tended to increase 3 months after bariatric surgery. IGFBP-1 increased while IGFBP-3 and total IGF-II decreased postoperatively, but these changes were unassociated with the development of DR. Markers of the metabolic syndrome improved.

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Authors and Affiliations

  1. Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark

    Troels Brynskov, Caroline Schmidt Laugesen & Torben Lykke Sørensen

  2. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Troels Brynskov & Torben Lykke Sørensen

  3. Department of Bariatric Surgery, Zealand University Hospital Køge, Køge, Denmark

    Andrea Karen Floyd

  4. Medical Research Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Jan Frystyk

  5. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark

    Jan Frystyk

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  1. Troels Brynskov
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  2. Caroline Schmidt Laugesen
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Correspondence to Troels Brynskov.

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Conflicts of Interest

Troels Brynskov was supported by unrestricted grants from the following nonprofit organizations: Fight for Sight Denmark, the Bagenkop Nielsen Myopia Foundation, and the Research Foundation of Region Zealand. The other co-authors declare no conflicts of interest.

Ethical Approval

All procedures were in accordance with the regional ethical research committee (approval #SJ-205) and with the 1964 Helsinki declaration and its later amendments.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Brynskov, T., Laugesen, C.S., Floyd, A.K. et al. The IGF-Axis and Diabetic Retinopathy Before and After Gastric Bypass Surgery. OBES SURG 27, 408–415 (2017). https://doi.org/10.1007/s11695-016-2303-0

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