scholarly journals Genetic Testing to Predict Weight Loss and Diabetes Remission and Long-Term Sustainability after Bariatric Surgery: A Pilot Study

2019 ◽  
Vol 8 (7) ◽  
pp. 964 ◽  
Author(s):  
Andreea Ciudin ◽  
Enzamaria Fidilio ◽  
Angel Ortiz ◽  
Sara Pich ◽  
Eduardo Salas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Genetic Testing ◽  
Pilot Study ◽  
Diabetes Remission ◽  
Risk Scores ◽  
Diabetic Patients ◽  
Type 2 Diabetic

Introduction: The aim of this pilot study was to assess genetic predisposition risk scores (GPS) in type 2 diabetic and non-diabetic patients in order to predict the better response to bariatric surgery (BS) in terms of either weight loss or diabetes remission. Research Design and Methods: A case-control study in which 96 females (47 with type 2 diabetes) underwent Roux-en-Y gastric by-pass were included. The DNA was extracted from saliva samples and SNPs were examined and grouped into 3 GPS. ROC curves were used to calculate sensitivity and specificity. Results: A highly sensitive and specific predictive model of response to BS was obtained by combining the GPS in non-diabetic subjects. This combination was different in diabetic subjects and highly predictive of diabetes remission. Additionally, the model was able to predict the weight regain and type 2 diabetes relapse after 5 years’ follow-up. Conclusions: Genetic testing is a simple, reliable and useful tool for implementing personalized medicine in type 2 diabetic patients requiring BS.

scholarly journals Risk stratification score for acute myocardial infarction and sudden cardiac death in type 2 diabetes mellitus

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Lee ◽  
J Zhou ◽  
CL Guo ◽  
WKK Wu ◽  
WT Wong ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiac Death ◽  
Adverse Outcomes ◽  
Risk Scores ◽  
Diabetic Patients ◽  
Type 2 Diabetic

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute myocardial infarction (AMI) and sudden cardiac death (SCD) are major cardiovascular adverse outcomes in patients with type 2 diabetic mellitus. Although there are many risk scores on composite outcomes of major cardiovascular adverse outcomes or cardiovascular mortality for diabetic patients, these existing scores did not account for the difference in pathogenesis and prognosis between acute coronary syndrome and lethal ventricular arrhythmias. Furthermore, recent studies reported that HbA1c and lipid levels, which were often accounted for in these risk scores, have J/U-shaped relationships with adverse outcomes. Purpose The present study aims to evaluate the application of incorporating non-linear J/U-shaped relationships between mean HbA1c and cholesterol levels into risk scores for predicting for AMI and non-AMI related SCD respectively, amongst type 2 diabetes mellitus patients. Methods This was a territory-wide cohort study of patients with type 2 diabetes mellitus above the age 40 and free from prior AMI and SCD, with or without prescriptions of anti-diabetic agents between January 1st, 2009 to December 31st, 2009 at government-funded hospitals and clinics in Hong Kong. Risk scores were developed for predicting incident AMI and non-AMI related SCD. The performance of conditional inference survival forest (CISF) model compared to that of random survival forests (RSF) model and multivariate Cox model. Results This study included 261308 patients (age = 66.0 ± 11.8 years old, male = 47.6%, follow-up duration = 3552 ± 1201 days, diabetes duration = 4.77 ± 2.29 years). Mean HbA1c and high-density lipoprotein-cholesterol (HDL-C) were significant predictors of AMI under multivariate Cox regression and were linearly associated with AMI. Mean HbA1c and total cholesterol were significant multivariate predictors with a J-shaped relationship with non-AMI related SCD. The AMI and SCD risk scores had an area-under-the-curve (AUC) of 0.666 (95% confidence interval (CI)= [0.662, 0.669]) and 0.677 (95% CI= [0.673, 0.682]), respectively. CISF significantly improves prediction performance of both outcomes compared to RSF and multivariate Cox models. Conclusions A holistic combination of demographic, clinical, and laboratory indices can be used for the risk stratification of type 2 diabetic patients against AMI and SCD.

scholarly journals Good Glycemic Outcomes Following Bariatric Surgery Among Patients With Type 2 Diabetes, Obesity, and Low-Titer GAD Antibodies

2020 ◽  
Author(s):  
Ruveena Kaur ◽  
David Kim ◽  
Richard Cutfield ◽  
Michael Booth ◽  
Lindsay Plank ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Diabetes Remission ◽  
Acid Decarboxylase ◽  
Gad Antibodies ◽  
C Peptide ◽  
Glycemic Outcomes ◽  
Design And Methods

<i>Objective</i>: To evaluate diabetes remission after bariatric surgery by presence of glutamic acid decarboxylase (GAD) antibody among those with obesity and Type 2 diabetes (T2D). <p> </p><i>Research Design and Methods</i>: Screening GAD was performed in 221 patients with T2D and obesity referred for bariatric surgery. 9/16 patients with GAD and 112/205 without GAD proceeded with surgery. Diabetes remission and weight loss was compared by GAD presence. <p> </p><i>Results</i>: GAD titres were 16-91 IU/mL in the first group. Both groups were similar in age, BMI, diabetes duration, insulin treated proportion, HbA1c and C-peptide (1354 ± 548 vs 1358 ± 487pmol/L). At 1 and 5 years post-operatively, both groups achieved similar BMI reduction and diabetes remission (67% vs 73%, p=0.71, and 56% vs 57%, p=1.0). <p><i> </i></p><i>Conclusion</i>: Low-titre GAD in patients with T2D and retained C-peptide, should not be a deterrent for bariatric surgery when the principal aim is diabetes remission.

scholarly journals Good Glycemic Outcomes Following Bariatric Surgery Among Patients With Type 2 Diabetes, Obesity, and Low-Titer GAD Antibodies

2020 ◽  
Author(s):  
Ruveena Kaur ◽  
David Kim ◽  
Richard Cutfield ◽  
Michael Booth ◽  
Lindsay Plank ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Diabetes Remission ◽  
Acid Decarboxylase ◽  
Gad Antibodies ◽  
C Peptide ◽  
Glycemic Outcomes ◽  
Design And Methods

<i>Objective</i>: To evaluate diabetes remission after bariatric surgery by presence of glutamic acid decarboxylase (GAD) antibody among those with obesity and Type 2 diabetes (T2D). <p> </p><i>Research Design and Methods</i>: Screening GAD was performed in 221 patients with T2D and obesity referred for bariatric surgery. 9/16 patients with GAD and 112/205 without GAD proceeded with surgery. Diabetes remission and weight loss was compared by GAD presence. <p> </p><i>Results</i>: GAD titres were 16-91 IU/mL in the first group. Both groups were similar in age, BMI, diabetes duration, insulin treated proportion, HbA1c and C-peptide (1354 ± 548 vs 1358 ± 487pmol/L). At 1 and 5 years post-operatively, both groups achieved similar BMI reduction and diabetes remission (67% vs 73%, p=0.71, and 56% vs 57%, p=1.0). <p><i> </i></p><i>Conclusion</i>: Low-titre GAD in patients with T2D and retained C-peptide, should not be a deterrent for bariatric surgery when the principal aim is diabetes remission.

scholarly journals Factors determining chance of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a nationwide cohort study in 8057 Swedish patients

2021 ◽  
Vol 9 (1) ◽  
pp. e002033
Author(s):  
Erik Stenberg ◽  
Torsten Olbers ◽  
Yang Cao ◽  
Magnus Sundbom ◽  
Anders Jans ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Metabolic Surgery ◽  
First Generation ◽  
Hemoglobin A1c ◽  
Diabetes Remission ◽  
Factors Associated ◽  
Generation Immigrant

IntroductionBariatric and metabolic surgery is an effective treatment option for type 2 diabetes (T2D). Increased knowledge regarding factors associated with diabetes remission is essential in individual decision making and could guide postoperative care. Therefore, we aimed to explore factors known to affect the chance of achieving diabetes remission after bariatric and metabolic surgery and to further investigate the impact of socioeconomic factors.Research design and methodsIn this nationwide study, we assessed all patients with T2D who underwent Roux-en-Y gastric bypass (RYGB) surgery between 2007 and 2015 in the Scandinavian Obesity Surgery Registry. Remission was defined as absence of antidiabetic medication for T2D 2 years after surgery. Multivariable logistic regression was used to evaluate factors associated with diabetes remission, with missing data handled by multiple imputations.ResultsA total of 8057 patients were included. Mean age±SD was 47.4±10.1 years, mean body mass index 42.2±5.7 kg/m2, mean hemoglobin A1c 59.0±17.33, and 61.7% (n=4970) were women. Two years after surgery, 6211 (77.1%) patients achieved T2D remission. Preoperative insulin treatment (OR 0.26, 95% CI 0.22 to 0.30), first-generation immigrant (OR 0.66, 95% CI 0.57 to 0.77), duration of T2D (OR 0.89, 95% CI 0.88 to 0.90), dyslipidemia (OR 0.71, 95% CI 0.62 to 0.81), age (OR 0.97, 95% CI 0.96 to 0.97), and high glycosylated hemoglobin A1c (HbA1c) (OR 0.99, 95% CI 0.98 to 0.99) were all associated with lower T2D remission rate. In contrast, residence in a medium-sized (OR 1.39, 95% CI 1.20 to 1.61) or small (OR 1.46, 95% CI 1.25 to 1.71) town and percentage of total weight loss (OR 1.04, 95% CI 1.03 to 1.04) were associated with higher remission rates.ConclusionAmong patients with T2D undergoing RYGB surgery, increasing age, HbA1c, and diabetes duration decreased the chance of reaching diabetes remission without cut-offs, while postoperative weight loss demonstrated a positive linear association. In addition, being a first-generation immigrant and living in a large city were socioeconomic factors having a negative association.

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