title: Urinary albumin excretion, HMW adiponectin, and insulin sensitivity in type 2 diabetic patients undergoing bariatric surgery.
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 percent) 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.
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q7, Cleveland, OH 44195, USA. navanes@ccf.org
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.forename: Karen R
authors.initials: KR
authors.lastname: Kelly
authors.forename: Firas
authors.initials: F
authors.lastname: Sabbagh
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.forename: John P
authors.initials: JP
authors.lastname: Kirwan
authors.forename: Sangeeta R
authors.initials: SR
authors.lastname: Kashyap
mesh_terms: D052242:Adiponectin / Q000097:blood*; D000419:Albuminuria / Q000453:epidemiology*; D050110:Bariatric Surgery; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000378:metabolism* / Q000652:urine; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood; D008297:Male; D008875:Middle Aged; D008970:Molecular Weight; D009767:Obesity, Morbid / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D010865:Pilot Projects; D012307:Risk Factors; D015431:Weight Loss / Q000502:physiology*
chemical_list: D052242:Adiponectin; D001786:Blood Glucose; D007328:Insulin; D020738:Leptin; D002784:Cholesterol; D003404:Creatinine