Preoperative Circulating Succinate Levels as a Biomarker for Diabetes Remission After Bariatric Surgery
Ceperuelo-Mallafré V (1,2), Llauradó G (2,3), Keiran N (1,2), Benaiges E (1,2), Astiarraga B (1,2,4), Martínez L (1), Pellitero S (2,5), González-Clemente JM (2,6), Rodríguez A (7), Fernández-Real JM (4), Lecube A (8), Megía A (1,2), Vilarrasa N (2,9), Vendrell J (10,2,11), Fernández-Veledo S (12,2).
(1) Institut d'Investigació Sanitària Pere Virgili, Endocrinology and Nutrition Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
(2) CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
(3) Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
(4) Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona, CIBEROBN (CB06/03/010) and ISCIII, Girona, Spain.
(5) Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute, Barcelona, Spain.
(6) Department of Endocrinology and Nutrition, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (Universitat Autònoma de Barcelona), Sabadell, Spain.
(7) Metabolic Research Laboratory, Clínica Universidad de Navarra, CIBEROBN, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
(8) Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
(9) Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
(10) Institut d'Investigació Sanitària Pere Virgili, Endocrinology and Nutrition Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
(11) Rovira I Virgili University, Tarragona, Spain.
(12) Institut d'Investigació Sanitària Pere Virgili, Endocrinology and Nutrition Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
This study was conducted 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 of 88 obese patients with diabetes assigned to RYGB or SG based on clinical criteria.
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] µmol/L vs. 64.1 [52.5-82.9] µmol/L; P = 0.018). Moreover, succinate concentrations were significantly decreased 1 year after surgery (58.9 [46.4-82.4] µmol/L vs. 46.0 [35.8-65.3] µmol/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.
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.
CITATION Diabetes Care. 2019 Aug 2. pii: dc190114. doi: 10.2337/dc19-0114