Changes in Adipokines following Laparoscopic Roux-en-Y Gastric Bypass Surgery in Chinese Individuals with Type 2 Diabetes Mellitus and BMI of 22–30 kg·m⁻²

Abstract

Aims. Although altered endocrine changes following bariatric surgery in morbidly obese patients with diabetes have been demonstrated by previous studies, little is known about their effects on low BMI patients of T2DM. We investigated the changes in adipokines and sICAM-1 in Chinese subjects with low BMI and T2DM after LRYGB and explored their relationship with postsurgical insulin sensitivity. Methods. Plasma levels of adiponectin, sICAM-1, fasting glucose, glycated hemoglobin, and fasting insulin and serum levels of visfatin were measured before and at three months after LRYGB in 33 T2DM patients with BMI of 22–30 kg·m−2. Results. Significant reductions in anthropometric measurements and indicators of glucose and lipid metabolism and moderate reductions in insulin resistance and fasting insulin were observed at three months after LRYGB. Postoperative adiponectin level (P < 0.001) was increased compared to the preoperative level, whereas visfatin (P < 0.001) and sICAM-1 (P < 0.001) were lower than that before surgery. Serum adiponectin negatively correlated with HOMA-IR and FIns both preoperatively and at three months after surgery, and visfatin positively correlated with HOMA-IR and FIns both preoperatively and postoperatively. Conclusion. Changes in adipokines were related to an improvement in postsurgical insulin sensitivity, which was predicted by weight loss after LRYGB even in low BMI patients with T2DM.

Downregulation of CTRP-3 by Weight Loss In Vivo and by Bile Acids and Incretins in Adipocytes In Vitro

“…Reduction of body weight and BMI might have been expected to be accomplished by an increase of CTRP-3. The observed decline is also contrary to the upregulation of circulating adiponectin upon bariatric surgery [27,28], which is closely related to CTRP-3 regarding immuno-metabolic functions and molecular structure. A possible explanation might be given by the rapid and extensive loss of fat mass achieved by both intervention strategies.…”

Does bariatric surgery improve adipose tissue function?

“…In support of this hypothesis Coughlin et al found adiponectin expression to be highly upregulated in femoral adipose tissue after surgery. Both visfatin and chemerin have generally been found to decrease after surgery , and some studies report a correlation between reductions in the levels of these adipokines and improvements of other metabolic parameters such as insulin resistance, fatty liver and/or inflammation Whether the secretion of adipokines plays a significant role in the improved metabolic state after surgery or is rather just a reflection of changes in adipose tissue mass is not fully elucidated and there are still mechanisms of action with many of the newly discovered adipokines, that are not well understood yet, but it has been described that adiponectin production in SAT after surgery is doubled after only 2 weeks – before significant weight loss has occurred – suggesting weight loss independent adipokine responses.…”

Laparoscopic metabolic surgery for the treatment of type 2 diabetes in Asia: a scoping review and evidence-based analysis

“… RCT Kim 2014 [ 30 ] Korea 25.3 ± 3.2 9.6 ± 5.2 LSAGB 107 (53:54) 46 ± 11 After LSAGB surgery in non-obese T2DM patients, the control of T2DM was possible safely and effectively. Case Series Shrestha 2013 [ 31 ] China 26.71 ± 0.69 < 10 LRYGB 33 (24:9) 49.51 ± 1.33 An improvement in postsurgical insulin sensitivity, after LRYGB even in low BMI patients with T2DM. Case Series Lakdawala 2013 [ 32 ] China 30–35 8.4 (3.5–14.5) LRYGB 52 (27:25) 49 (20–65) LRYGB is a safe, efficacious, and cost-effective treatment for uncontrolled T2DM in patients with a BMI of 30–35 kg/m 2 Case Series Wu 2013 [ 33 ] China 30.15 ± 1.73 4.9 ± 2.7 LRYGB 8 (2:6) 42.25 ± 9.95 Roux-en-Y gastric bypass has a beneficial effect on weight loss and glucose metabolism in obese type 2 diabetes patients with lower BMI Case Series Zhu 2012 [ 34 ] China 26.20 ± 3.56 5.98 ± 4.54 LRYGB 30 (22:8) 48.16 ± 3.56 LRYGB is beneficial for non-obese T2DM patients in China Case Series Huang 2011 [ 35 ] Taiwan, China 30.81 (25.00–34.80) 6.57 (1–20) LRYGB 22 (2:20) 47 (28–63) Early intervention in low-BMI patients yields better remission rates because age, BMI, and duration of T2DM predict glycemic outcomes.…”