Preoperative Fasting Plasma C-Peptide Level May Help to Predict Diabetes Outcome After Gastric Bypass Surgery

Abstract

A preoperative fasting plasma C-peptide level <1.0 nmol/l in severely obese T2DM patients indicates partial β-cell failure, and is associated with a markedly reduced chance of complete resolution of T2DM after RYGB. We therefore advocate measuring C-peptide levels in all diabetic patients up for bariatric surgery to improve the prediction of outcome.

Comment on: Is glycosylated hemoglobin A1 c associated with increased risk for severe early postoperative complications in nondiabetics after laparoscopic gastric bypass?

“…Our institution asks for fasting c-peptide. We find, like other studies, that presurgical c-peptide of r1.5 suggests less than optimal resolution of diabetes [12]. Keep in mind that other studies have verified that c-peptide levels improve, no matter at what level they start, after RYGB.…”

“…This confirms what we already know, that insulin resistance and pancreatic health improve after RYGB by several well-defined mechanisms (altered ghrelin, ileal break, and other neurochemical mechanisms). Lifestyle change, including diet, exercise, and focusing on lipid and glucose markers, is well documented in the many reviews of the Look AHEAD research group [12].…”

Visceral fat area as a new predictor of short-term diabetes remission after Roux-en-Y gastric bypass surgery in Chinese patients with a body mass index less than 35 kg/m2

“…Many previous studies demonstrated that preoperative fasting C-peptide levels might be helpful for predicting T2DM outcome after RYGB [15][16][17]. In T2DM, C-peptide levels are above the normal range because of a compensatory increase in insulin production.…”

Comment on: Visceral fat area as a new predictor of short-term diabetes remission after Roux-en-Y gastric bypass surgery in Chinese patients with a body mass index less than 35 kg/m2

“…However, these results are easily adapted to different ethnicities as well. Again, these findings reinforce the need for an immediate review of currently flawed guidelines for surgical indication for patients with uncontrolled T2DM (16). Patients with insulin resistance, appear to benefit more from metabolic surgery than those with more severe β-cell dysfunction.…”