Preoperative Circulating Succinate Levels as a Biomarker for Diabetes Remission After Bariatric Surgery
Por:
Ceperuelo-Mallafre, V, Llaurado, G, Keiran, N, Benaiges, E, Astiarraga, B, Martinez, L, Pellitero, S, Gonzalez-Clemente, JM, Rodriguez, A, Fernandez-Real, JM, Lecube, A, Megia, A, Vilarrasa, N, Vendrell, J and Fernandez-Veledo, S
Publicada:
1 oct 2019
Ahead of Print:
2 ago 2019
Resumen:
OBJECTIVE To determine the potential use of baseline circulating succinate to predict type 2 diabetes remission after bariatric surgery. RESEARCH DESIGN AND METHODS Forty-five obese patients with diabetes were randomly assigned to Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or laparoscopic greater curvature plication. Anthropometric parameters were evaluated, and a complete biochemical analysis including circulating serum succinate concentrations was performed at baseline and 1 year after surgery. The results were externally validated in a second cohort including 88 obese patients with diabetes assigned to RYGB or SG based on clinical criteria. RESULTS Succinate baseline concentrations were an independent predictor of diabetes remission after bariatric surgery. Patients achieving remission after 1 year had lower levels of baseline succinate (47.8 [37.6-64.6] mu mol/L vs. 64.1 [52.5-82.9] mu mol/L; P = 0.018). Moreover, succinate concentrations were significantly decreased 1 year after surgery (58.9 [46.4-82.4] mu mol/L vs. 46.0 [35.8-65.3] mu mol/L, P = 0.005). In multivariate analysis, the best logistic regression model showed that baseline succinate (odds ratio [OR] 11.3, P = 0.031) and the type of surgery (OR 26.4, P = 0.010) were independently associated with remission. The C-statistic for this model was 0.899 (95% CI 0.809-0.989) in the derivation cohort, which significantly improved the prediction of remission compared with current available scores, and 0.729 (95% CI 0.612-0.846) in the validation cohort. Interestingly, patients had a different response to the type of surgery according to baseline succinate, with significant differences in remission rates. CONCLUSIONS Circulating succinate is reduced after bariatric surgery. Baseline succinate levels have predictive value for diabetes remission independently of previously described presurgical factors and improve upon the current available scores to predict remission.
Filiaciones:
Ceperuelo-Mallafre, V:
Hosp Univ Tarragona Joan XXIII, Endocrinol & Nutr Serv, Inst Invest Sanitaria Pere Virgili, Tarragona, Spain
ISCIII, CIBER Diabet & Enfermedades Metabol Asociadas CIB, Madrid, Spain
Llaurado, G:
ISCIII, CIBER Diabet & Enfermedades Metabol Asociadas CIB, Madrid, Spain
Hosp del Mar, Inst Hosp Mar Invest Med IMIM, Dept Endocrinol & Nutr, Barcelona, Spain
Keiran, N:
Hosp Univ Tarragona Joan XXIII, Endocrinol & Nutr Serv, Inst Invest Sanitaria Pere Virgili, Tarragona, Spain
ISCIII, CIBER Diabet & Enfermedades Metabol Asociadas CIB, Madrid, Spain
Benaiges, E:
Hosp Univ Tarragona Joan XXIII, Endocrinol & Nutr Serv, Inst Invest Sanitaria Pere Virgili, Tarragona, Spain
ISCIII, CIBER Diabet & Enfermedades Metabol Asociadas CIB, Madrid, Spain
Astiarraga, B:
Hosp Univ Tarragona Joan XXIII, Endocrinol & Nutr Serv, Inst Invest Sanitaria Pere Virgili, Tarragona, Spain
ISCIII, CIBER Diabet & Enfermedades Metabol Asociadas CIB, Madrid, Spain
Inst Invest Biomed Girona, CIBEROBN 006 03 010, Dept Diabet Endocrinol & Nutr, Girona, Spain
ISCIII, Girona, Spain
Martinez, L:
Hosp Univ Tarragona Joan XXIII, Endocrinol & Nutr Serv, Inst Invest Sanitaria Pere Virgili, Tarragona, Spain
:
ISCIII, CIBER Diabet & Enfermedades Metabol Asociadas CIB, Madrid, Spain
Germans Trias & Pujol Res Inst, Dept Endocrinol & Nutr, Barcelona, Spain
Gonzalez-Clemente, JM:
ISCIII, CIBER Diabet & Enfermedades Metabol Asociadas CIB, Madrid, Spain
Univ Autonoma Barcelona, Inst Invest & Innovacio Parc Tauli, Corp Sanitaria Parc Tauli, Dept Endocrinol & Nutr,Hosp Sabadell, Sabadell, Spain
Rodriguez, A:
Inst Invest Sanitaria Navarra, CIBEROBN, Clin Univ Navarra, Metab Res Lab, Pamplona, Spain
Fernandez-Real, JM:
Inst Invest Biomed Girona, CIBEROBN 006 03 010, Dept Diabet Endocrinol & Nutr, Girona, Spain
ISCIII, Girona, Spain
Lecube, A:
Hosp Arnau Vilanova, Endocrinol & Nutr Dept, Lleida, Spain
Megia, A:
Hosp Univ Tarragona Joan XXIII, Endocrinol & Nutr Serv, Inst Invest Sanitaria Pere Virgili, Tarragona, Spain
ISCIII, CIBER Diabet & Enfermedades Metabol Asociadas CIB, Madrid, Spain
Vilarrasa, N:
ISCIII, CIBER Diabet & Enfermedades Metabol Asociadas CIB, Madrid, Spain
Hosp Univ Bellvitge, Obes Unit, Barcelona, Spain
Hosp Univ Bellvitge, Endocrinol Dept, Barcelona, Spain
Hosp Univ Bellvitge, Nutr Dept, Barcelona, Spain
Vendrell, J:
Hosp Univ Tarragona Joan XXIII, Endocrinol & Nutr Serv, Inst Invest Sanitaria Pere Virgili, Tarragona, Spain
ISCIII, CIBER Diabet & Enfermedades Metabol Asociadas CIB, Madrid, Spain
Rovira & Virgili Univ, Tarragona, Spain
Fernandez-Veledo, S:
Hosp Univ Tarragona Joan XXIII, Endocrinol & Nutr Serv, Inst Invest Sanitaria Pere Virgili, Tarragona, Spain
ISCIII, CIBER Diabet & Enfermedades Metabol Asociadas CIB, Madrid, Spain
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