scholarly journals Presence of Liver Steatosis Is Associated With Greater Diabetes Remission After Gastric Bypass Surgery

Diabetes Care ◽  
2020 ◽  
pp. dc200150
Author(s):  
Roman Vangoitsenhoven ◽  
Rickesha L. Wilson ◽  
Deepa V. Cherla ◽  
Chao Tu ◽  
Sangeeta R. Kashyap ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Liver Steatosis ◽  
Diabetes Remission

A126 Presence of liver steatosis is associated with greater diabetes remission after gastric bypass surgery

2019 ◽  
Vol 15 (10) ◽  
pp. S18
Author(s):  
Ali Aminian ◽  
Sangeeta Kashyap ◽  
David E. Cummings ◽  
Deepa Cherla ◽  
Philip Schauer ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Liver Steatosis ◽  
Diabetes Remission

Presence of Liver Steatosis Is Associated With Greater Diabetes Remission After Gastric Bypass Surgery

2020 ◽  
Author(s):  
Roman Vangoitsenhoven ◽  
Rickesha Wilson ◽  
Deepa V Cherla ◽  
Chao Tu ◽  
Sangeeta R Kashyap ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Metabolic Surgery ◽  
Gastric Bypass Surgery ◽  
Liver Steatosis ◽  
Multivariable Analysis ◽  
Diabetes Remission ◽  
Independent Association ◽  
Glycemic Outcomes ◽  
Design And Methods

<b>Objective</b>: Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance (IR) and beta-cell dysfunction. Ectopic fat accumulation in liver and muscle causes IR. Since bariatric and metabolic surgery significantly improves fatty liver disease, <a>we hypothesized that coexistence of liver steatosis (i.e., when hepatic IR contributes in T2DM) would be associated with greater diabetes improvement after surgery.</a> <p> </p> <p><b>Research design and methods</b>: A total of 519 patients with T2DM who underwent Roux-en-Y gastric bypass and simultaneous liver biopsy and had a minimum 5-year follow-up were analyzed to assess the independent association between biopsy-proven liver steatosis and postoperative long-term diabetes remission (glycated hemoglobin < 6.5% off medications).</p> <p> </p> <p><b>Results</b>: Of the 407 patients with biopsy-proven liver steatosis, long-term diabetes remission was achieved in 211 (52%) patients, compared with 44/112 (39%) remission in patients without steatosis (P=0.027). In multivariable analysis, presence of liver steatosis was an independent predictor of long-term diabetes remission (odds ratio 1.96, [95% confidence interval 1.04 – 3.72], <i>P</i>=0.038). Hepatocyte ballooning, lobular inflammation, or fibrosis at baseline did not predict diabetes remission.</p> <p> </p> <p><b>Conclusion</b>: This study, for the first time, suggests that in patients with T2DM who are considering bariatric and metabolic surgery, coexistence of liver steatosis is associated with better long-term glycemic outcomes. Furthermore, our data suggest that there are different variants of T2DM wherein metabolic responses to surgical weight loss are different. A subgroup of patients whose T2DM is characterized by the presence of hepatic steatosis (presumably associated with worse IR) experience better postoperative metabolic outcomes.</p>

scholarly journals Using convolutional neural network to predict remission of diabetes after gastric bypass surgery: a machine learning study from the Scandinavian Obesity Surgery Register (Preprint)

2020 ◽  
Author(s):  
Yang Cao ◽  
Ingmar Näslund ◽  
Erik Näslund ◽  
Johan Ottosson ◽  
Scott Montgomery ◽  
...  
Keyword(s):  
Neural Network ◽  
Gastric Bypass ◽  
Complete Remission ◽  
Obesity Surgery ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Diabetes Remission ◽  
Predictive Capability ◽  
Final Test ◽  
Better Than

BACKGROUND Prediction of diabetes remission is an important topic in the evaluation of patients with type-2 diabetes (T2D) before bariatric surgery. While several high-quality predictive indices are available, artificial intelligence (AI) algorithms offer the potential for higher predictive capability. OBJECTIVE The objective was to construct and validate an AI prediction model for diabetes remission after Roux-en-Y gastric bypass surgery. METHODS Patients who underwent surgery from 2007 until 2017 were included in the study, with collection of individual data from the Scandinavian Obesity Surgery Registry (SOReg), the Swedish National Patients Register, the Swedish Prescribed Drugs Register, and Statistics Sweden. A 7-layer convolution neural network (CNN) model was developed using 80% of patients randomly selected from SOReg and 20% of patients for external testing. The predictive capability of the CNN model and currently used scores (DiaRem, Ad-DiaRem, DiaBetter and IMS) were compared. RESULTS In total, 8057 patients with T2D were included in the study. At 2 years after surgery 77.1% achieved pharmacological remission, while 62.2% achieved complete remission. The area under the receiver operating curve (AUC) for the CNN-model for pharmacological remission was 0.85 [95% confidence interval (CI): 0.83-0.86] during validation, and 0.83 for the final test, which was 9-12% better than the traditional predictive indices. AUC for complete remission was 0.83 (95% CI: 0.81-0.85) during validation, and 0.82 for the final test, which was 9-11% better than the traditional predictive indices. CONCLUSIONS The CNN method had better predictive capability compared to traditional indices for diabetes remission. However, further validation is needed in other countries to evaluate its external generalizability.

scholarly journals Presence of Liver Steatosis Is Associated With Greater Diabetes Remission After Gastric Bypass Surgery

2020 ◽  
Author(s):  
Roman Vangoitsenhoven ◽  
Rickesha Wilson ◽  
Deepa V Cherla ◽  
Chao Tu ◽  
Sangeeta R Kashyap ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Metabolic Surgery ◽  
Gastric Bypass Surgery ◽  
Liver Steatosis ◽  
Multivariable Analysis ◽  
Diabetes Remission ◽  
Independent Association ◽  
Glycemic Outcomes ◽  
Design And Methods

<b>Objective</b>: Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance (IR) and beta-cell dysfunction. Ectopic fat accumulation in liver and muscle causes IR. Since bariatric and metabolic surgery significantly improves fatty liver disease, <a>we hypothesized that coexistence of liver steatosis (i.e., when hepatic IR contributes in T2DM) would be associated with greater diabetes improvement after surgery.</a> <p> </p> <p><b>Research design and methods</b>: A total of 519 patients with T2DM who underwent Roux-en-Y gastric bypass and simultaneous liver biopsy and had a minimum 5-year follow-up were analyzed to assess the independent association between biopsy-proven liver steatosis and postoperative long-term diabetes remission (glycated hemoglobin < 6.5% off medications).</p> <p> </p> <p><b>Results</b>: Of the 407 patients with biopsy-proven liver steatosis, long-term diabetes remission was achieved in 211 (52%) patients, compared with 44/112 (39%) remission in patients without steatosis (P=0.027). In multivariable analysis, presence of liver steatosis was an independent predictor of long-term diabetes remission (odds ratio 1.96, [95% confidence interval 1.04 – 3.72], <i>P</i>=0.038). Hepatocyte ballooning, lobular inflammation, or fibrosis at baseline did not predict diabetes remission.</p> <p> </p> <p><b>Conclusion</b>: This study, for the first time, suggests that in patients with T2DM who are considering bariatric and metabolic surgery, coexistence of liver steatosis is associated with better long-term glycemic outcomes. Furthermore, our data suggest that there are different variants of T2DM wherein metabolic responses to surgical weight loss are different. A subgroup of patients whose T2DM is characterized by the presence of hepatic steatosis (presumably associated with worse IR) experience better postoperative metabolic outcomes.</p>

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