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Targeting adiponectin, fat loss after bariatric surgery could boost diabetes remission
After bariatric surgery, smaller rises in adiponectin are seen in patients who have not achieved remission from type 2 diabetes, according to research published in Diabetes, Obesity and Metabolism.
Adjunctive strategies to promote greater fat loss, raise adiponectin or both together, therefore, could improve remission rates, according to researchers at the Cleveland Clinic.
“Although remission of diabetes is well recognized following bariatric surgery, a number of patients with diabetes do not achieve remission, or undergo relapse of diabetes control, despite initial weight loss,” Sangeeta Kashyap, MD, of the Endocrinology and Metabolism Institute, told Endocrine Today.
Sangeeta Kashyap
The findings shed light on how remission status relates to the production of gut hormones and incretin levels of glucagon-like polypeptide-1 (GLP-1), gastric inhibitory peptide (GIP) and ghrelin, compared with insufficient weight loss, Kashyap noted.
“This study suggests that inadequate fat loss and rises in adiponectin may be responsible for this phenomena,” Kashyap said. “In fact, surgical non-responders had higher concentration of GLP-1 hormone levels than surgical responders.”
Kashyap, along with Steven K. Malin, PhD, of the Department of Pathobiology, and colleagues studied 40 adults (mean BMI, 36; age, 48 years; HbA1c, 9.7%) who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) as part of the Surgical Treatment and Medication Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial.
The researchers investigated the metabolic determinants of non-remission in patients at 12 months and 24 months; only 37 patients (RYGB, n=18; SG, n=19) had follow-up data for the 2-year mark.
Remission was defined as maintaining HbA1c <6.5% and fasting glucose <126 mg/dL without antidiabetic medication. Insulin secretion and sensitivity indices were calculated based on plasma glucose, insulin and C-peptide values during a 120-minute mixed-meal tolerance test.
The researchers also assessed: body fat; incretins including GLP-1, GIP and ghrelin; and adipokines including adiponectin, leptin, tumor necrosis factor-alpha and high-sensitivity C-reactive protein (hs-CRP).
Bariatric surgery induced type 2 diabetes remission rates of 40% at 12 months and 27% at 24 months. Total and abdominal fat loss, insulin secretion, insulin sensitivity and beta-cell function showed better improvement in patients with remission at both 12 and 24 months than patients without remission.
Incretin levels were not related to type 2 diabetes remission. However, hs-CRP decreased and adiponectin increased more in patients with remission than without.
Baseline adiponectin levels were the only predictor for lower HbA1c levels at 12 and 24 months. Further, elevated adiponectin correlated with enhanced beta-cell function, lower triglyceride levels and fat loss.
“The clinical implications of our findings are that adjunctive medical strategies promoting greater fat loss and/or raising adiponectin with diet, exercise and drugs may be key for higher diabetes remission rates after bariatric surgery,” Kashyap said. — by Allegra Tiver
Disclosure: Please see study for a full list of the researchers’ financial disclosures.