Decreased serum CA19‐9 is associated with improvement of insulin resistance and metabolic control in patients with obesity and type 2 diabetes after Roux‐en‐Y gastric bypass

Abstract

Aims/IntroductionPatients with type 2 diabetes are known to show elevated serum levels of carbohydrate antigen 19-9 (CA19-9). The aim of the present study was to investigate the possible relationships of CA19-9 with metabolic control, insulin resistance (IR), and pancreatic β-cell function in patients with obesity and type 2 diabetes who underwent Roux-En-Y gastric bypass (RYGB).Materials and MethodsThe present study included 81 healthy volunteers, and 33 patients diagnosed with obesity and type 2 diabetes who underwent RYGB. Anthropometry, serum levels of CA19-9, glucose and lipid metabolic profiles, and serum insulin levels were determined at baseline and at 12 weeks after RYGB.ResultsChanges in CA19-9 were significantly and positively correlated with changes in fasting plasma glucose (r = 0.552, P = 0.001), 2-h post-challenge plasma glucose levels (r = 0.623, P = 0.000), glycated hemoglobin levels (r = 0.819, P = 0.000), glycated albumin levels (r = 0.711, P = 0.000), total cholesterol (r = 0.449, P = 0.009) and the Homeostasis Model of Assessment-IR index (r = 0.407, P = 0.019). Furthermore, a multiple stepwise regression analysis showed that the changes in serum levels of CA19-9 were independently and significantly associated with changes in glycated hemoglobin (β = 0.598, P = 0.000), fasting plasma glucose (β = 0.309, P = 0.000) and Homeostasis Model of Assessment-IR (β = 0.235, P = 0.010) after adjusting for confounding factors.ConclusionsCA19-9 could be an effective indicator of IR, and glycemic and lipid metabolism in patients with obesity and type 2 diabetes after rapid metabolic control by RYGB. Additionally, CA19-9 might be a marker with which to evaluate the short-term effects of glycolipid toxicity on IR in these patients.

<p>Synergistic Association of Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 on the Risk of Abnormal Glucose Regulation</p>

“…Esteghamati et al 31 reported significant associations of CA19-9 with HbA1c and insulin resistance, and these associations were persistent in subjects with diabetes but not in those without diabetes. Tu et al 32 found that insulin resistance is an important contributing factor in the changes in serum levels of CA19-9 after rapid metabolic control by Roux-en-Y gastric bypass. Since glucose toxicity is associated with insulin resistance and changes in the serum levels of CA19-9, 61 the association between elevated CA19-9 and hyperglycemia might be involved in the mechanisms of both beta-cell dysfunction and insulin resistance.…”

“…22 Numerous studies have reported that circulating CA19-9 is elevated during hyperglycemia in patients with diabetes. [23][24][25][26][27][28][29][30][31][32] CA19-9 levels were revealed to be associated with hemoglobin A1c (HbA1c) and fasting blood glucose and to be decreased after improvement of glycemic control. 28,33 The mechanism of elevated serum CA19-9 in diabetic patients remains unclear.…”

“…However, some studies reported associations between CA19-9 elevation, β-cell function and insulin resistance. 27,31,32 In addition, circulating CEA has been reported to increase in patients with diabetes [33][34][35][36][37][38] and was positively associated with HbA1c. 38,39 CEA levels are also reported to be associated with insulin resistance.…”

Proposed cut-off value of CA19-9 for detecting pancreatic cancer in patients with diabetes: a case-control study

“…The higher cut-off value of 75 U/mL would result in an increase of false-negatives. It has been reported that an elevated serum levels of CA19-9 in patients with diabetes were decreased within 2 weeks by improvement of glycemic control [10,15,16]. Therefore, when serum CA 19-9 is between 37 and 75 U/mL, it would seem reasonable to re-examine the patient at least 2 weeks after • cut-off value of CA19-9 with the maximum sensitivity + specificity for predicting pancreatic cancer (75 U/mL).…”

“…Diabetes is also associated with an increased risk of pancreatic cancer [6]. However, the serum level of CA19-9 is elevated in patients with poorly controlled diabetes [7][8][9], while it is normalized by improvement of glycemic control [10,11]. Thus, serum CA19-9 exceeds 37 U/mL in some patients with diabetes although they do not have pancreatic cancer.…”