title: Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes.
abstract: OBJECTIVE
  To find clinically meaningful preoperative predictors of diabetes remission and conversely inadequate glycemic control after gastric bypass surgery. Predicting the improvement in glycemic control in those with type 2 diabetes after bariatric surgery may help in patient selection.
  
  
  METHODS
  Preoperative details of 154 ethnic Chinese subjects with type 2 diabetes were examined for their influence on glycemic outcomes at 1 year after gastric bypass. Remission was defined as HbA(1c) ≤6%. Analysis involved binary logistic regression to identify predictors and provide regression equations and receiver operating characteristic curves to determine clinically useful cutoff values.
  
  
  RESULTS
  Remission was achieved in 107 subjects (69.5%) at 12 months. Diabetes duration <4 years, body mass >35 kg/m(2), and fasting C-peptide concentration >2.9 ng/mL provided three independent preoperative predictors and three clinically useful cutoffs. The regression equation classification plot derived from continuous data correctly assigned 84% of participants. A combination of two or three of these predictors allows a sensitivity of 82% and specificity of 87% for remission. Duration of diabetes (with different cutoff points) and C-peptide also predicted those cases in which HbA(1c) ≤7% was not attained. Percentage weight loss after surgery was also predictive of remission and of less satisfactory outcomes.
  
  
  CONCLUSIONS
  The glycemic response to gastric bypass is related to BMI, duration of diabetes, fasting C-peptide (influenced by insulin resistance and residual β-cell function), and weight loss. These data support and refine previous findings in non-Asian populations. Specific ethnic and procedural regression equations and cutoff points may vary.
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: John B
authors.initials: JB
authors.lastname: Dixon
authors.forename: Lee-Ming
authors.initials: LM
authors.lastname: Chuang
authors.forename: Keong
authors.initials: K
authors.lastname: Chong
authors.forename: Shu-Chun
authors.initials: SC
authors.lastname: Chen
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Lambert
authors.forename: Nora E
authors.initials: NE
authors.lastname: Straznicky
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Lambert
authors.forename: Wei-Jei
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D014280:Triglycerides / Q000097:blood; D014527:Uric Acid / Q000097:blood; D055815:Young Adult
chemical_list: D001219:Aspartate Aminotransferases; D001786:Blood Glucose; D002097:C-Reactive Protein; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D014280:Triglycerides; D014527:Uric Acid