title: Restoration of glycemic control in patients with type 2 diabetes mellitus after bariatric surgery is associated with reduction in microparticles.
abstract: BACKGROUND
  Microparticles bud from cellular elements during inflammation and are associated with the vascular dysfunction related to type 2 diabetes mellitus. Although weight loss is known to reduce inflammation, the metabolic effects of bariatric surgery on microparticle concentration and composition are not known. Our objectives were to determine the effect of bariatric surgery on the microparticle concentration and to correlate these changes with clinical parameters in a multispecialty group practice.
  
  
  METHODS
  We studied 14 obese subjects with type 2 diabetes mellitus 2 weeks before and 1 and 12 months after bariatric surgery. Of the 14 patients, 9 underwent Roux-en-Y gastric bypass and 5 gastric restrictive surgery.
  
  
  RESULTS
  At 1 month after surgery, the body mass index had decreased by ∼10%, glycemic control had improved dramatically (P < .01), and a >60% reduction in endothelial and platelet microparticles and C-reactive protein levels (P < .05) had occurred. The tissue factor microparticles had decreased by 40% (P = .1). At 12 months after surgery, the body mass index had decreased by ∼20%, glycemic control was maintained (P < .01), and a >50% reduction in monocyte microparticles compared with before surgery was found. The reduction in monocyte microparticles 1 month after surgery was strongly associated with the reduction in hemoglobin A1c (P < .05). The reduction in monocyte microparticles 12 months after surgery correlated strongly with the reduction in body mass index (P < .05).
  
  
  CONCLUSIONS
  The reduction in microparticles after bariatric surgery in patients with type 2 diabetes mellitus reflects an attenuation of inflammation, and this mechanism might contribute to normalization of glycemic control.
authors.affiliation: Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Vicky
authors.initials: V
authors.lastname: Cheng
authors.forename: Sangeeta R
authors.initials: SR
authors.lastname: Kashyap
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.forename: John P
authors.initials: JP
authors.lastname: Kirwan
authors.forename: Keith R
authors.initials: KR
authors.lastname: McCrae
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D055252:Cell-Derived Microparticles / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000473:pathology / Q000601:surgery*; D004730:Endothelium, Vascular / Q000473:pathology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000473:pathology; D009767:Obesity, Morbid / Q000097:blood / Q000473:pathology / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D013925:Thromboplastin / Q000378:metabolism; D015431:Weight Loss / Q000502:physiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D018950:Lipopolysaccharide Receptors; D013925:Thromboplastin
references.citation: Eur Heart J. 2006 Apr;27(7):817-23
references.pmid: 16434416
references.citation: Arterioscler Thromb Vasc Biol. 2006 Dec;26(12):2775-80
references.pmid: 17038634
references.citation: Diabetes. 2003 Dec;52(12):2882-7
references.pmid: 14633847
references.citation: J Am Coll Cardiol. 2005 May 17;45(10):1622-30
references.pmid: 15893178
references.citation: J Clin Invest. 2003 Dec;112(12):1785-8
references.pmid: 14679172
references.citation: Diabetologia. 2002 Apr;45(4):550-5
references.pmid: 12032632
references.citation: Int J Obes (Lond). 2009 Apr;33(4):456-64
references.pmid: 19238154
references.citation: Diabetes Res Clin Pract. 2005 Jun;68(3):193-201
references.pmid: 15936460
references.citation: Am J Med. 2009 Mar;122(3):248-256.e5
references.pmid: 19272486
references.citation: Diabetes. 2002 Sep;51(9):2840-5
references.pmid: 12196479
references.citation: Int J Obes (Lond). 2011 Dec;35(12):1479-86
references.pmid: 21386797
references.citation: Int J Obes (Lond). 2010 Mar;34(3):462-71
references.pmid: 20029383
references.citation: J Biol Chem. 2010 Jan 29;285(5):3428-38
references.pmid: 19940134
references.citation: Circulation. 2002 Nov 5;106(19):2442-7
references.pmid: 12417540
references.citation: J Clin Endocrinol Metab. 2008 Dec;93(12):4656-63
references.pmid: 18765510