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Beta-cell function indicates prospects for diabetes remission after weight-loss surgery success
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The success of weight-loss surgery in patients with type 2 diabetes depends on their preoperative ability to produce insulin, according to recent study findings published in The Journal of Physiology.
“Our study shows that the patients’ ability to produce insulin is decisive for whether or not the procedure eliminates diabetes,” Flemming Dela, MD, of the Center for Healthy Aging at the University of Copenhagen, Denmark, said in a press release. “Measuring the insulin cells’ performance before surgery can, thus, provide us with a much better bias from which to predict who will actually benefit from the surgery. This type of measurement is not currently included in doctors’ assessments.”
Dela and colleagues evaluated 15 patients with type 2 diabetes and 18 patients without type 2 diabetes (controls) scheduled for a Roux-en-Y gastric bypass (RYGB) surgery procedure to determine beta-cell function before and 4 and 18 months after surgery.
All participants had 25 g oral glucose tolerance tests and IV glucose tolerance tests performed at inclusion, after a diet-induced weight loss, and 4 and 18 months after RYGB.
During OGTT throughout the study, plasma glucose concentrations expressed as area under the curve (AUC) were greater in the diabetes group compared with controls (P < .001) but were lower in both groups after surgery (P < .003). Compared with controls, plasma insulin concentrations were lower in the diabetes group during OGTTs (P = .02) and 18 months after RYGB compared with prior tests in both groups (P < .01). Insulin secretion rates were lower among the diabetes group compared with controls (P = .02). These rates did not change in either group after diet or RYGB. Compared with controls, beta-cell glucose sensitivity was lower in the diabetes group but increased after RYGB.
During the IV glucose tolerance test, glucose concentrations were greater in the diabetes group compared with controls (P < .001). Compared with controls, insulin concentrations were lower in the diabetes group (P < .007) and decreased after RYGB in both groups (P < .001). Before and 4 months after RYGB, insulin secretion rates were lower in the diabetes group compared with controls (P < .04), but no differences were found 18 months after RYGB.
“The ability to produce sufficient amounts of insulin is inversely related to duration of the disease,” Dela said. “The longer the patient has had diabetes, the poorer the ability to produce insulin. Thus, these new results also point to the importance of undergoing and operating at an early stage, before the patients lose their ability to produce insulin.”
In an accompanying editorial, Faidon Magkos, MSc, PhD, and Samuel Klein, MD, both of the Washington University School of Medicine, St. Louis, wrote that more studies are needed with larger populations to “determine precise values that can be used to establish reliable cut-off points for predicting diabetes outcomes, specifically the likelihood of who will achieve [type 2 diabetes] remission and who will fail to achieve clinically important benefits in glycemic control.”
– by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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