Gastric bypass surgery reveals independency of obesity and diabetes melitus type 2.
BACKGROUND
Roux-en-Y gastric bypass surgery is widely applied to ameliorate morbid obesity, including diabetes in people with type 2 diabetes. The latter vanish a few days after surgery for many, but not in all patients before any weight reduction has occurred. The explanation for this change in metabolic status is poorly understood, but the observation may suggest that the fate obesity and diabetes is only partly linked after surgery.


METHODS
The trajectories of weight reduction measured as reduced body mass index (BMI) in 741obese subjects with and without diabetes were evaluated. Evaluation was performed on three groups: 1) subjects that were non-diabetic before and after surgery; 2) subjects that were diabetics before surgery but non-diabetics after surgery; and 3) subjects that were diabetics before surgery and remained diabetics after surgery. The diabetic state was established at HbA1c above 48 mmol/mol.


RESULTS
The trajectories differ significantly between groups and any sub-populations of groups, the latter identified by the distance between individual trajectories using a k-means procedure. The results suggest that different domains in the enormous genetic network governing basic metabolism are perturbed in obesity and diabetes, and in fact some of the patients are affected by two distinct diseases: obesity and diabetes mellitus type 2.


CONCLUSIONS
Although RYGB "normalized" many glycaemic parameters in some of the diabetic subjects apparently converting to a non-diabetics state, other diabetic subjects stay diabetic in the context of the new gut anatomy after surgery. Thus, the obesity part of the glycaemic derangement may have been ameliorated, but some defects of the diabetic state had not.
Department of Clinical Biochemistry, University Hospital of Copenhagen, Kettegaards Alle 30, 2650, Hvidovre, Denmark. mogens.fenger@regionh.dk.
Mogens
M
Fenger
Department of Clinical Medicine, University Hospital of Zeeland, Køge, Denmark.
Dorte Lindqvist
DL
Hansen
Department of Clinical Medicine, University Hospital of Zeeland, Køge, Denmark.
Dorte
D
Worm
Department of Surgical Gastroenterology, University Hospital of Copenhagen, Kettegaards Alle 30, 2650, Hvidovre, Denmark.
Lisbeth
L
Hvolris
Department of Surgical Gastroenterology, University Hospital of Copenhagen, Kettegaards Alle 30, 2650, Hvidovre, Denmark.
Viggo B
VB
Kristiansen
Department of Clinical Biochemistry, University Hospital of Copenhagen, Kettegaards Alle 30, 2650, Hvidovre, Denmark.
Elin Rebecka
ER
Carlsson
Department of Endocrinology, University Hospital of Copenhagen, Kettegaards Alle 30, 2650, Hvidovre, Denmark.
Sten
S
Madsbad
D001786:Blood Glucose; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D015390:Gastric Bypass; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D009765:Obesity / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D012307:Risk Factors; D016896:Treatment Outcome
D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human