Gastric bypass improves glycemic control and reduces systemic inflammation in non-severely obese patients (BMI < 35 kg/m2) with type 2 diabetes mellitus

• Published in: Diabetologie und Stoffwechsel
• Main Authors: Billeter, A, Vittas, S, Israel, B, Schulte, T, Büchler, MW, Hidmark, A, Fleming, TH, Müller, BP, Nawroth, PP
• Format: Conference Proceeding
• Language: English
• Published: 29.04.2015
• ISSN: 1861-9002; 1861-9010
• DOI: 10.1055/s-0035-1549796

Introduction: Bariatric surgery has been shown to improve type 2 diabetes mellitus (T2DM) in obese patients. Based on these findings, the ability of Roux-en-Y gastric bypass (RYGB) to improve glycemic control in non-severely obese patients and the effects on systemic cytokine levels were investigated. Methods: Twenty consecutive patients with a body mass index (BMI) between 25 – 35 kg/m 2 and a poorly controlled, insulin-dependent T2DM were enrolled. All patients were treated with a standardized RYGB. Parameters of glycemic control, serum and isolated circulating monocytes were collected over 24 months. Cytokines in the serum were analyzed using ELISAs and monocyte gene expression was determined using real-time PCR. Data is presented as mean ± SEM. Results: HbA1c and fasting glucose decreased from 8.5 ± 0.3% to 7.0 ± 0.3% (p < 0.05) and 201 ± 16 mg/dl to 128 ± 7 mg/dl (p < 0.05), respectively. Daily insulin and metformin use decreased from 81.6 ± 10.6IE to 4.7 ± 1.8IE (p < 0.05) and 1125 ± 222 mg to 782 ± 191 mg (p = 0.2). Serum TNF, CCL-2 (MCP-1), and C-reactive protein all significantly decreased while IL-4 and IL-13 showed a significant increase. Corresponding to these changes in systemic cytokine levels, inflammation related genes (NFkB p65, TNF-α and VEGFA) showed a significant decrease over time in circulating monocytes. In addition, genes participating in the antioxidant defense (Glyoxalase I and HSP4) and mitochondrial genes (mtCOI) were also found to decrease over the study period. Conclusion: RYGB improves glycemic control and reduces insulin use in non-severely obese patients with T2DM. These changes are associated with a decrease in systemic inflammation and a change towards a type 2 inflammation.