Type 2 Diabetes Mellitus Remission in Obese Patients Under Bariatric Surgery: The Role of Preoperative Triglycerides Levels

Background: There is abundant evidence reporting the relationship between triglycerides levels and type 2 diabetes mellitus, however few studies confirmed the influence of triglycerides levels on the incidence of diabetes. Bariatric surgery may lead to the remission of type 2 diabetes mellitus, but the effect of basal serum triglycerides levels on this reversal is unknown. This study aimed to assess the association between preoperative triglycerides levels and pre- and type 2 diabetes mellitus remission in obese patients one year after bariatric surgery.

Methods: A retrospective study was conducted among 1959 obese patients who underwent bariatric surgery in our entre. Data on socio-demographic and clinical characteristics were used. Pre-diabetes and type 2 diabetes mellitus remission was defined as normal glycaemic measures at least one year’s duration without pharmacological therapy. Logistic regression models, crude and adjusted for sex, age, preoperative serum triglycerides levels and type of bariatric surgery, were used.

Results: The median of preoperative serum triglycerides level was 121.00 (SD=75.00) mg/dL, and 34.7% and 30.0% of patients presented pre- and type 2 diabetes mellitus, respectively, at baseline. Preoperative serum triglycerides levels were higher in type 2 diabetes mellitus patients (139.00 vs. 106.00 mg/dL, in normal glycaemic patients; p<0.001) and showed to be significantly correlated with fasting glycaemia, glycated

haemoglobin, homeostasis model assessment of insulin resistance and homeostasis model assessment of β-cell function. One year after bariatric surgery, 62.5% of patients with pre- or type 2 diabetes at baseline showed remission. Preoperative serum triglycerides levels were negatively associated with this remission (OR: 0.997; 95%CI=0.995–0.998), independently of, sex, age and type of bariatric surgery. Conclusions: One year after bariatric surgery, 62.5% of patients showed pre- or type 2 diabetes mellitus remission, being the preoperative serum triglycerides levels an important clinical parameter for remission.

Keywords: triglycerides, diabetes, remission, obesity, bariatric surgery

MON-584 Albuminuria and Obesity - Which Are the Associated Factors?

Introduction

The association between obesity and renal dysfunction has been widely studied. Albuminuria is a cardiovascular risk factor and the most prevalent marker of kidney injury in people with obesity. Despite the higher prevalence of hypertension and diabetes in those patients, other contributing factors are still unknown.

We aimed to explore the factors related to albuminuria in obesity, analyzing its variation after bariatric surgery.

Methods

We evaluated 2518 patients undergoing bariatric surgery, of those, 1243 with preoperative albuminuria measurement were included in this study. Albuminuria was determined by the albumin-creatinine ratio (RAC) in an occasional urine sample (mg/g) or by the 24-hour urine albumin excretion rate (TEA) (mg/24h). Means and medians were compared using Student’s T-test or Mann-Whitney tests, respectively. Spearman correlation was used.

Results Age (ρ = 0.073; p = 0.010), body mass index (BMI) (ρ = 0.139; p <0.001), waist circumference (WC) (ρ = 0.220; p <0.001), glycated hemoglobin (HbA1C) (ρ = 0.221; p <0.001), systolic blood pressure (SBP) (ρ = 0.203; p <0.001), diastolic blood pressure (DBP) (ρ = 0.134; p <0.001), uricemia (ρ = 0.141; p <0.001) and C-reactive protein (CRP) levels (ρ = 0.090; p = 0.017) were positively correlated with albuminuria.Patients with albuminuria (TEA / RAC≥30) had higher BMI (45.0 ± 6.0 vs.43.2 ± 5.6kg / m2; p <0.001), WC (129.3 ± 13.1 vs. 122.0 ± 12.9cm; p <0.001), SBP (142.7 ± 18.0 vs.134.1 ± 16.5mmHg; p <0.001), DBP (88.0 ± 12.6 vs.83, 2 ± 10.3mmHg; p <0.001), uricemia (6.1 ± 1.5 vs.5.4 ± 1.4mg / dL; p <0.001) and CRP (11.3 (16.4) vs.8, 3 (9.6) mg / L; p <0.001).Excluding patients with diabetes and hypertension, BMI and WC remained statistically positively correlated with urinary albumin excretion. After surgery, the decrease of albuminuria was correlated with the reduction of HbA1C (ρ = 0.144; p <0.001) and CRP (ρ = 0.113; p = 0.037).

Conclusion Anthropometric, inflammatory and metabolic factors, namely WC, CRP and uricemia, may be involved in the etiopathogenesis of albuminuria in obese patients. Bariatric surgery is the most effective method to reverse obesity and it has been shown to be a promising therapy on the treatment of associated renal dysfunction.

MON-592 The Impact of Bariatric Surgery on the Risk of Non-Alcoholic Fatty Liver Disease in Morbidly Obese Patients

Introduction: Non-alcoholic fatty liver disease (NAFLD) is strongly associated with obesity, and the prevalence of both diseases is increasing notably. The lack of effective treatment options for NAFLD is leading to a great consideration towards the identification of new approaches.

Aim: We aimed to evaluate the change one year after bariatric surgery of parameters of hepatic function and in the hepatic scores, Fatty Liver Index (FLI, predictor of hepatic steatosis), and BARD, BMI, AST/ALT ratio and DM, (predictor of hepatic fibrosis).

Methods: Observational retrospective cohort study in morbidly obese patients that underwent bariatric surgery between January 2010 and July 2018. We excluded patients missing hepatic function parameters before or one year after the surgical procedure. We used two linear regression models: 1) unadjusted; 2) adjusted for surgery type (gastric sleeve, gastric band and gastric bypass), sex, age, body mass index, diabetes and dyslipidaemia.

Results: The included population (n=1955) had an average age of 43.1±10 years and 85.8% were female. We observed a relevant decrease in transaminases (pre-operative AST and ALT, 24.8±12.4 and 29.5±19.5U/L, vs 22.4 ± 11.1 and 22.2±14.7 post-operatively, respectively, p&lt;0.01) and gamma-glutamyltransferase (36.9±35.4 vs 21.4±22.0U/L, p&lt;0.01), and an increase in alkaline phosphatase (77.8±23.5 vs 80.8±25.4U/L, p&lt;0.01) and total bilirubin (0.56±0.23 vs 0.68±0.24mg/dL, p&lt;0.01). Both FLI and BARD markedly decrease one year after surgery (p&lt;0.01). Comparing the surgical procedures, gastric sleeve was associated with a greater reduction of hepatic enzymes and of both FLI and BARD comparing with gastric band. Comparing with gastric bypass, sleeve was associated with a greater reduction of transaminases and alkaline phosphatase, but a smaller reduction of FLI and BARD.

Conclusion: Bariatric surgery is associated with a reduction of the hepatic enzymes and an improvement of FLI and BARD. Bariatric surgery may represent an effective therapeutic approach to NAFLD.