Superior socioeconomic status in patients with type 2 diabetes having gastric bypass surgery: a case-control analysis of 10 642 individuals

Abstract

IntroductionThe incidence of type 2 diabetes mellitus (T2DM) is increasing, in parallel with the epidemic of obesity. Although bariatric surgery, which profoundly affects T2DM, has increased 10-fold since the millennium, only a fraction of diabetics is offered this treatment option.ObjectiveTo investigate the association between clinical and socioeconomic factors in selecting patients with T2DM for bariatric surgery in a publicly financed healthcare system.Research design and methodsCohort study using prospectively registered data from two nationwide quality registers, the Scandinavian Obesity Surgery Registry (SOReg) and the Swedish National Diabetes Register (NDR), and data from two government agencies. An age, gender and body mass index-matched case-control analysis containing 10 642 patients with T2DM was performed.ResultsPatients with T2DM having bariatric surgery had a higher education level (upper secondary school or college level, OR 1.42% and 95% CI (1.29 to 1.57) and 1.33 (1.18 to 1.51), respectively) as well as a higher income (OR 1.37 (1.22 to 1.53) to 1.94 (1.72 to 2.18) for quartile 2–4) than non-operated patients. Operated patients were more often married or had been married (OR 1.51 (1.37 to 1.66) and 1.65 (1.46 to 1.86), respectively) as well as natives (OR 0.84 (0.73 to 0.95) if born in the rest of Europe). Groups did not differ regarding relevant laboratory data and present medication, nor in former in-patient diagnoses.ConclusionDespite similar clinical data, superior socioeconomic status was associated with increased rate of bariatric surgery in patients with T2DM. We believe that this warrants actions, for example concerning referral patterns.

JKAMP inhibits the osteogenic capacity of adipose-derived stem cells in diabetic osteoporosis by modulating the Wnt signaling pathway through intragenic DNA methylation

“…The hyperglycemic microenvironment caused by diabetes exacerbates damage of osteoblasts. Chronic inflammation in diabetic patients inhibits the activity of stem cells and increases calcium excretion [ 1 , 34 , 35 ]. Additionally, the interaction of hyperglycemia with parathyroid hormone and the vitamin D system weakens bone turnover in diabetic patients and reduces osteocalcin produced by osteoblasts [ 36 , 37 ].…”

LncRNA‐AK137033 inhibits the osteogenic potential of adipose‐derived stem cells in diabetic osteoporosis by regulating Wnt signaling pathway via DNA methylation

“… 31 Chronic hyperglycemia causes chronic damage to various tissues and organs of the body, which results in various diabetic complications, especially in the eyes, kidneys, blood vessels, and bones. 32 , 33 , 34 Among them, diabetic osteoporosis refers to the metabolic bone disease that occurs because of the hyperglycemic microenvironment. 32 Recent studies have shown that insulin deficiency or tolerance in diabetic patients leads to disruptions of glucose, lipid, and calcium metabolisms, which results in dysfunctional osteoblasts and osteoclasts and ultimately causes systemic bone loss and a reduction in bone mineral density.…”

“… 32 , 33 , 34 Among them, diabetic osteoporosis refers to the metabolic bone disease that occurs because of the hyperglycemic microenvironment. 32 Recent studies have shown that insulin deficiency or tolerance in diabetic patients leads to disruptions of glucose, lipid, and calcium metabolisms, which results in dysfunctional osteoblasts and osteoclasts and ultimately causes systemic bone loss and a reduction in bone mineral density. 35 , 36 Additionally, hyperglycemic microenvironment‐induced autophagy adversely affects the proliferation and differentiation of osteoblasts, which is associated with increases in fracture risk and bone mineral density loss in diabetes.…”

JKAMP Inhibits the Osteogenic Capacity of Adipose-derived Stem Cells in Diabetic Osteoporosis by Modulating the Wnt Signaling Pathway Through Intragenic DNA Methylation

“…The hyperglycemic microenvironment caused by diabetes exacerbates damage of osteoblasts. Chronic inflammation in diabetic patients inhibits the activity of stem cells and increases calcium excretion [1,32,33]. Additionally, the interaction of hyperglycemia with parathyroid hormone and the vitamin D system weakens bone turnover in diabetic patients and reduces osteocalcin produced by osteoblasts [34,35].…”