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Association between the preoperative fasting and postprandial C-peptide AUC with resolution of type 2 diabetes 6 months following bariatric surgery

Akhila Mallipedhi, Thinzar Min, Sarah Prior Orcid Logo, Claire MacIver, Steve D. Luzio, Gareth Dunseath Orcid Logo, Richard Bracken Orcid Logo, Saiful Islam Orcid Logo, Jonathan D. Barry, Scott Caplin, Jeffrey Stephens Orcid Logo, Steve Luzio Orcid Logo

Metabolism

Swansea University Authors: Sarah Prior Orcid Logo, Gareth Dunseath Orcid Logo, Richard Bracken Orcid Logo, Saiful Islam Orcid Logo, Jeffrey Stephens Orcid Logo, Steve Luzio Orcid Logo

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DOI (Published version): 10.1016/j.metabol.2015.08.009

Abstract

Background and AimsBariatric surgery results in the remission of type 2 diabetes mellitus (T2DM) in morbidly obese subjects. The aim of the study was to investigate the predictive value of both static and dynamic measures of C-peptide in relation to T2DM resolution 6 months after bariatric surgery r...

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Published in: Metabolism
Published: 2015
URI: https://cronfa.swan.ac.uk/Record/cronfa22971
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Abstract: Background and AimsBariatric surgery results in the remission of type 2 diabetes mellitus (T2DM) in morbidly obese subjects. The aim of the study was to investigate the predictive value of both static and dynamic measures of C-peptide in relation to T2DM resolution 6 months after bariatric surgery regardless of the operation type.Methods and ResultsA non-randomized prospective study of 24 participants with T2DM undergoing bariatric surgery. Measurements of fasting and 2-hour plasma glucose, insulin, C-peptide and measures of insulin sensitivity were recorded temporally during an oral glucose tolerance test pre-operatively and 6 months post-operatively. A responder was defined with a fasting glucose < 5.6mmol/L and HBA1c < 6.0% postoperatively. Within the sample there were 11 responders and 13 non-responders at 6 months. There was a significant difference in the duration of diabetes between the groups. Fasting C-peptide (P≤0.05) and 2-hour C-peptide (P≤0.05) were higher in responders compared to non-responders. Significantly higher C-peptide levels were observed preoperatively at all time points for responders, with significantly higher area under the curve (AUC0–60 and AUC0–120). Using the lower quartiles for C-peptide levels, both fasting C-peptide (> 2.5ng/mL [0.83nmol/L]) and 2-hour C-peptide (> 5.2ng/mL [1.73nmol/L]) had a sensitivity and negative predictive value of 100% to predict T2DM remission. Logistic regression showed C-peptide, duration of diabetes and BMI were associated with response. The area under the ROC curve was 0.94 and a regression model predicted diabetes remission with a sensitivity of 85.7% and a specificity of 88.9%.ConclusionsThis study demonstrated that static (fasting) and dynamic (AUC, 2-hour) C-peptide measurements predict T2DM resolution 6 months following bariatric surgery. This work provides insight into C-peptide dynamics as a predictor of response to bariatric surgery.
College: Swansea University Medical School