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Weight-loss Independent Clinical and Metabolic Biomarkers Associated with Type 2 Diabetes Remission

Kusuma Chaiyasoot1,2,3, Naomi S Sakai4, Roxanna Zakeri1

  • 1Department of Medicine, Centre for Obesity Research, University College London, London, UK.

Obesity Surgery
|November 1, 2023
PubMed
Abstract

Insights

Type 2 diabetes remission after bariatric surgery is linked to improved beta-cell function and acyl ghrelin levels. Targeting visceral adipose tissue and branched-chain amino acid metabolism may enhance remission rates.

Area of Science:

  • Metabolic surgery research
  • Diabetes remission mechanisms
  • Obesity and metabolic health

Background:

  • Bariatric surgery effectively treats type 2 diabetes (T2D) in many patients, but remission mechanisms are not fully understood.
  • Identifying factors beyond weight loss is crucial for optimizing T2D remission strategies.
  • This study investigates clinical, metabolic, and genetic predictors of T2D remission post-surgery.

Purpose of the Study:

  • To identify weight-loss independent factors associated with type 2 diabetes remission after bariatric surgery.
  • To explore novel clinical, metabolic, and genetic associations with T2D remission.
  • To comprehensively phenotype patients who achieved T2D remission versus those who did not.

Main Methods:

  • Matched observational study comparing 10 T2D remitters and 10 non-remitters.
  • Detailed phenotyping including body composition (MRI), gut hormones, metabolomics, and insulin sensitivity.
  • Assessment of genetic risk scores for T2D and anthropometric traits.

Main Results:

  • Remitters exhibited enhanced beta-cell function and higher circulating acyl ghrelin levels.
  • Lower visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT) ratio was observed in remitters.
  • Branched-chain amino acids (BCAAs) and VLDL particle size were key discriminant metabolites; BCAAs correlated positively with VAT and negatively with beta-cell function.

Conclusions:

  • A novel relationship between VAT and BCAAs may influence glucoregulatory control.
  • Improved beta-cell function and ghrelin's role are key to T2D remission post-surgery.
  • Targeting VAT reduction and BCAA metabolism could improve long-term T2D remission rates.
Keywords:
Metabolic surgeryObesityRemissionType 2 diabetes

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