title: Attenuated improvements in adiponectin and fat loss characterize type 2 diabetes non-remission status after bariatric surgery.
abstract: OBJECTIVE
  To identify the metabolic determinants of type 2 diabetes non-remission status after bariatric surgery at 12 and 24 months.
  
  
  METHODS
  A total of 40 adults [mean ± sd body mass index 36 ± 3 kg/m(2) , age 48 ± 9 years, glycated haemoglobin (HbA1c) 9.7 ± 2%) undergoing bariatric surgery [Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG)] were enrolled in the present study, the Surgical Treatment and Medication Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial. Type 2 diabetes remission was defined as HbA1c <6.5% and fasting glucose <126 mg/dl (i.e. <7 mmol/l) without antidiabetic medication. Indices of insulin secretion and sensitivity were calculated from plasma glucose, insulin and C-peptide values during a 120-min mixed-meal tolerance test. Body fat, incretins (glucagon-like polypeptide-1, gastric inhibitory peptide, ghrelin) and adipokines [adiponectin, leptin, tumour necrosis factor-α, high-sensitivity C-reactive protein (hs-CRP)] were also assessed.
  
  
  RESULTS
  At 24 months, 37 patients had available follow-up data (RYGB, n = 18; SG, n = 19). Bariatric surgery induced type 2 diabetes remission rates of 40 and 27% at 12 and 24 months, respectively. Total fat/abdominal fat loss, insulin secretion, insulin sensitivity and β-cell function (C-peptide0-120 /glucose0-120 × Matsuda index) improved more in those with remission at 12 and 24 months than in those without remission. Incretin levels were unrelated to type 2 diabetes remission, but, compared with those without remission, hs-CRP decreased and adiponectin increased more in those with remission. Only baseline adiponectin level predicted lower HbA1c levels at 12 and 24 months, and elevated adiponectin correlated with enhanced β-cell function, lower triglyceride levels and fat loss.
  
  
  CONCLUSIONS
  Smaller rises in adiponectin level, a mediator of insulin action and adipose mass, characterize type 2 diabetes non-remission up to 2 years after bariatric surgery. Adjunctive strategies promoting greater fat loss and/or raising adiponectin may be key to achieving higher type 2 diabetes remission rates after bariatric surgery.
authors.affiliation: Department of Pathobiology, Cleveland Clinic, Cleveland, OH, USA; Department of Nutrition, Case Western Reserve University Cleveland Clinic, Cleveland, OH, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Malin
authors.forename: J
authors.initials: J
authors.lastname: Bena
authors.forename: B
authors.initials: B
authors.lastname: Abood
authors.forename: C E
authors.initials: CE
authors.lastname: Pothier
authors.forename: D L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: S
authors.initials: S
authors.lastname: Nissen
authors.forename: S A
authors.initials: SA
authors.lastname: Brethauer
authors.forename: P R
authors.initials: PR
authors.lastname: Schauer
authors.forename: J P
authors.initials: JP
authors.lastname: Kirwan
authors.forename: S R
authors.initials: SR
authors.lastname: Kashyap
mesh_terms: D052242:Adiponectin / Q000097:blood*; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D015390:Gastric Bypass; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D054795:Incretins / Q000378:metabolism; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood* / Q000601:surgery; D011446:Prospective Studies; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D052242:Adiponectin; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D054795:Incretins; C517652:hemoglobin A1c protein, human
keywords: diabetes; gastric bypass; glycaemic control; insulin secretion; obesity; sleeve gastrectomy