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Insulin sensitivity

Insulin sensitivity improves following adipokines changes

Changes predicted by weight loss even in low BMI diabetic patients

Changes in adipokines are related to improvements in post-surgical insulin sensitivity and was predicted by weight loss after LRYGB even in low BMI patients with type 2 diabetes, according to a study, published online in the International Journal of Endocrinology.

Despite the discovery, the study’s researchers from The Third Xiangya Hospital, Central South University, China, caution that “unravelling the pathogenesis and attaining in-depth exploration would require large-scale clinical studies and long-term follow-up that would further elucidate the effect of LRYGB in such patients.”

Adiponectin is an idiosyncratic collagen-like cytokine secreted by mature fat cells, and it directly regulates glucose metabolism and insulin sensitivity in vitro and in vivo through the activation of AMP-activated protein kinase (AMPK).

The investigators wanted to examine endocrine and metabolic changes post-LRYGB in Chinese patients with T2DM with BMI 22-30, focusing on adiponectin, visfatin, and sICAM-1 and explore their relationship with postsurgical insulin sensitivity.

They included 33 patients with type 2 diabetes (24 males, BMI 26.71±0.69, age 49.51±1.33 years), who underwent LRYGB from June 2009 to July 2011, in this case study.

In all of the procedures the proximal jejunum was transected 40cm distal to the ligament of Treitz, the alimentary limb was measured at 100cm, and a side-to-side jejunostomy was performed using 60mm linear cutter and 3.5mm stapler.

The jejunostomy and the mesenteric defects were subsequently closed with manually placed polyglactin (2–0 Vicryl, Ethicon,) sutures, and with nylon (2–0 Ethibond, Ethicon, UK) sutures respectively. A 25 ml proximal gastric pouch was created with 60 mm linear cutter and 3.5 mm stapler. Then, a 2.5 cm long gastrojejunostomy was formed with 30 mm linear cutter and 2.5 mm stapler at the antecolic position. The gastrojejunostomy was closed with manual sutures (2–0 Vicryl, Ethicon, USA), and a drain was placed near gastrojejunostomy around the right-upper quadrant.

Plasma levels of adiponectin, sICAM-1, fasting glucose, glycated haemoglobin, and fasting insulin and serum levels of visfatin were measured before and at three months after surgery.

Results

The outcomes at three months revealed significant reductions in anthropometric measurements and indicators of glucose and lipid metabolism and moderate reductions in insulin resistance and fasting insulin. Postoperative adiponectin level was increased compared to the preoperative level, whereas visfatin and sICAM-1 were lower than that before surgery.

The authors noted that 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.

The mean BMI of the postoperative participants whose adiponectin levels were below the median was significantly higher than of those whose adiponectin levels were above the median.

Prior to the study, 19 patients  (45.4%) were on oral hypoglycemic agents prior to surgery, and eight (21.2%) were on insulin, with the remaining six patients (33.3%) were using both oral hypoglycemic and insulin. After the surgery, 8 patients (24.2%) required no medication, four (12.1%) remained on insulin and 17 (51.5%) required oral hypoglycaemic agents but on a lesser dose than that before surgery.

“Multivariate analysis revealed that the changes in insulin sensitivity were predicted by weight loss,” write the authors. “Our study shows that the level of sICAM-1 was lower at three-month post-LRYGB than that before surgery.”

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