Abstract
Background
C-peptide is a surrogate of the pancreatic beta cell mass. However, the clinical significance of C-peptide in a diabetic patient after bariatric surgery has not been studied clearly.
Methods
From February 2005 to January 2009, a total of 205 (124 females and 81 males) consecutive morbidly obese patients with type 2 diabetes mellitus (T2DM) enrolled in a surgically supervised weight loss program with at least 1 year follow-up were examined. Among them, 147 patients (71.7%) received gastric bypass procedures, while the other 58 patients (28.3%) received restrictive-type procedures.
Results
The mean C-peptide before the surgery was 5.3 ± 3.5 ng/ml. One hundred nineteen patients (58.0%) had an elevated C-peptide (>4 ng/ml), while 2 patients (1.0%) had a low C-peptide (<1.0 ng/ml). Multivariate analysis confirmed that waist circumference, triglycerides, and HbA1c were the independent predictors for the elevation of C-peptide. It was observed that the mean C-peptide levels decreased to 1.7 ± 0.9 ng/ml 1 year after bariatric surgery with a mean reduction of 64.1%. One year after surgery, 160 patients (78.0%) out of a total of 205 patients had a remission of their T2DM. Patients in the bypass group had a higher diabetes remission rate (91.2%; 134 out of 147) in comparison to patients in the restrictive group (44.8%; 26 out of 58, p < 0.001). The diabetes remission rates for those with preoperative C-peptide <3, 3–6, and > 6 ng/ml were 26 out of 47 (55.3%), 87 out of 108 (82.0%), and 47 out of 52 (90.3%), p < 0.001, respectively.
Conclusions
Baseline C-peptide is commonly elevated in morbidly obese patients with T2DM. There was a marked reduction in C-peptide after a significant weight reduction 1 year after surgery with a T2DM remission rate of 78.0%. Thus, bariatric surgery is recommended for obesity-related T2DM patients with elevated C-peptide.
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References
King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.
UK Prospective Diabetes Study Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.
UK Prospective Diabetes Study Group. Effect of intensive blood glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPD 34). Lancet. 1998;352:854–65.
Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetes subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care. 2002;25:358–63.
Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–85.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
Berber B, Stenstrom G, Sundkvist G. Random C-peptide in the classification of diabetes. Scand J Clin Lab Invest. 2000;60:687–94.
Zimmet P, Turner R, McCarty D, et al. Crucial points at diagnosis. Type 2 diabetes or slow type 1 diabetes. Diab Care. 1999;22:B59–64.
Rubino F. Is type 2 diabetes an operable intestinal disease? Diabetes Care. 2008;31:S290–6.
Lee WJ, Wang W. Bariatric surgery: Asia-Pacific perspective. Obes Surg. 2005;15:751–7.
Tan CE, Ma S, Wai D, et al. Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians? Diabetes Care. 2004;27:1182–6.
Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and B-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia. 1985;28:412–9.
Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242:20–8.
Lee WJ, Wang W, Yu PJ, et al. Gastrointestinal quality of life following laparoscopic adjustable gastric banding in Asia. Obes Surg. 2006;16:586–91.
Chiu CC, Lee WJ, Wang W, et al. Prevention of trocar-wound hernia in laparoscopic bariatric operations. Obes Surg. 2006;16:913–8.
DePaula AL, Macedo AL, Rassi N, et al. Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35. Surg Endos. 2008;22:706–16.
Lee WJ, Wang W, Lee YC, et al. Effects of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI >35 and <35 kg/m2. J Gastrointest Surg. 2008;12:945–52.
Rubino F, Kaplan LM, Schauer PR, et al. The Diabetes Surgery Summit Consensus Conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg. 2010;251:399–405.
Lee WJ, Lee YC, Ser KH, et al. Improvement of insulin resistance after obesity surgery: a comparison of gastric banding and bypass procedures. Obes Surg. 2008;18:1119–25.
Hickey MS, Pories WJ, MacDonald Jr KG, et al. A new paradigm for type 2 diabetes mellitus. Could it be a disease of the foregut? Ann Surg. 1998;227:637–44.
Rubino F, Forgione A, Cummings D, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244:741–9.
Morinigo R, Moize V, Mustri M, et al. GLP-1, PYY, hunger and satiety following gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2006;91:1735–40.
Lee WJ, Huang MT, Wang W, et al. Effects of obesity surgery on metabolic syndrome. Arch Surg. 2004;139:1088–92.
Gasteyger C, Suter M, Gaillard RC, et al. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008;87:1128–33.
Kim S, Richards W. Long-term follow-up of the metabolic profiles in obese patients with type 2 diabetes mellitus after Roux-en-Y gastric bypass. Ann Surg. 2010;251:1049–55.
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This work was supported by the grant from Ming-Shen General Hospital (97-A-01).
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Lee, WJ., Chong, K., Ser, KH. et al. C-peptide Predicts the Remission of Type 2 Diabetes After Bariatric Surgery. OBES SURG 22, 293–298 (2012). https://doi.org/10.1007/s11695-011-0565-0
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DOI: https://doi.org/10.1007/s11695-011-0565-0