Preoperative Fasting C-Peptide Predicts Type 2 Diabetes Mellitus
Remission in Low-BMI Chinese Patients After Roux-en-Y Gastric Bypass
Received: 21 November 2017 /Accepted: 15 May 2018
2018 The Society for Surgery of the Alimentary Tract
Objective This study investigated the role of preoperative fasting C-peptide (FCP) levels in predicting diabetic outcomes in
low-BMI Chinese patients following Roux-en-Y gastric bypass (RYGB) by comparing the metabolic outcomes of patients
with FCP > 1 ng/ml versus FCP ≤ 1 ng/ml.
Methods The study sample included 78 type 2 diabetes mellitus patients with an average BMI < 30 kg/m
at baseline. Patients’
parameters were analyzed before and after surgery, with a 2-year follow-up. A univariate logistic regression analysis and
multivariate analysis of variance between the remission and improvement group were performed to determine factors that were
associated with type 2 diabetes remission after RYGB. Linear correlation analyses between FCP and metabolic parameters were
performed. Patients were divided into two groups: FCP > 1 ng/ml and FCP ≤ 1 ng/ml, with measured parameters compared
between the groups.
Results Patients’ fasting plasma glucose, 2-h postprandial plasma glucose, FCP, and HbA1c improved significantly after surgery
(p < 0.05). Factors associated with type 2 diabetes remission were BMI, 2hINS, and FCP at the univariate logistic regression
analysis (p < 0.05). Multivariate logistic regression analysis was performed then showed the results were more related to FCP
(OR = 2.39). FCP showed a significant linear correlation with fasting insulin and BMI (p < 0.05). There was a significant
difference in remission rate between the FCP > 1 ng/ml and FCP ≤ 1 ng/ml groups (p = 0.01). The parameters of patients with
FCP > 1 ng/ml, including BMI, plasma glucose, HbA1c, and plasma insulin, decreased markedly after surgery (p <0.05).
Conclusion FCP level is a significant predictor of diabetes outcomes after RYGB in low-BMI Chinese patients. An FCP level of
1 ng/ml may be a useful threshold for predicting surgical prognosis, with FCP > 1 ng/ml predicting better clinical outcomes
Keywords Roux-en-Y gastric bypass
Type 2 diabetes mellitus
The prevalence of type 2 diabetes mellitus (T2DM) in the
Chinese population has been increasing annually, representing
one of the most challenging public health problems.
Patients with obesity and T2DM can achieve sustainable
weight loss and diabetes remission after metabolic surgery.
Compared with conventional medical therapy, metabolic sur-
gery can also significantly improve glycemic control in obese
patients with T2DM.
Other investigations have shown that
metabolic surgery leads to greater weight loss and better gly-
cemic control and quality of life over a 3-year follow-up
Furthermore, compared to conventional medical
therapy, metabolic surgery has superior utility in improving
T2DM complications, such as macrovascular and microvas-
Additionally, T2DM patients with nonmorbid
obesity or overweight show better weight loss and glycemic
control after metabolic surgery.
gastric bypass (LRYGB) has been proven a safe and effective
Gastric bypass, combined with medical
and lifestyle management, is now recommended for T2DM
* Liyong Zhu
* Shaihong Zhu
Department of Gastrointestinal Surgery, The First Affiliated Hospital,
University of South China, Hengyang 421001, China
Department of General Surgery, Third Xiangya Hospital, Central
South University, Tongzipo Road, Changsha 410013, China
Journal of Gastrointestinal Surgery