PMID- 33323476
OWN - NLM
STAT- MEDLINE
DCOM- 20210820
LR  - 20220202
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Print)
IS  - 0149-5992 (Linking)
VI  - 44
IP  - 2
DP  - 2021 Feb
TI  - Presence of Liver Steatosis Is Associated With Greater Diabetes Remission After 
      Gastric Bypass Surgery.
PG  - 321-325
LID - 10.2337/dc20-0150 [doi]
AB  - OBJECTIVE: Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance 
      (IR) and beta-cell dysfunction. Ectopic fat accumulation in liver and muscle causes 
      IR. Since bariatric and metabolic surgery significantly improves fatty liver 
      disease, we hypothesized that coexistence of liver steatosis (i.e., when hepatic 
      IR contributes in T2DM) would be associated with greater diabetes improvement 
      after surgery. RESEARCH DESIGN AND METHODS: A total of 519 patients with T2DM who 
      underwent Roux-en-Y gastric bypass and simultaneous liver biopsy and had a 
      minimum 5-year follow-up were analyzed to assess the independent association 
      between biopsy-proven liver steatosis and postoperative long-term diabetes 
      remission (glycated hemoglobin <6.5% [48 mmol/mol] off medications). RESULTS: Of 
      the 407 patients with biopsy-proven liver steatosis, long-term diabetes remission 
      was achieved in 211 (52%) patients compared with remission in 44 out of 112 (39%) 
      patients without steatosis (P = 0.027). In multivariable analysis, presence of 
      liver steatosis was an independent predictor of long-term diabetes remission 
      (odds ratio 1.96 [95% CI 1.04-3.72]; P = 0.038). Hepatocyte ballooning, lobular 
      inflammation, or fibrosis at baseline did not predict diabetes remission. 
      CONCLUSIONS: This study, for the first time, suggests that in patients with T2DM 
      who are considering bariatric and metabolic surgery, coexistence of liver 
      steatosis is associated with better long-term glycemic outcomes. Furthermore, our 
      data suggest that there are distinct variants of T2DM in which metabolic 
      responses to surgical weight loss are different. A subgroup of patients whose 
      T2DM is characterized by the presence of hepatic steatosis (presumably associated 
      with worse IR) experience better postoperative metabolic outcomes.
CI  - (c) 2020 by the American Diabetes Association.
FAU - Vangoitsenhoven, Roman
AU  - Vangoitsenhoven R
AUID- ORCID: 0000-0003-3523-669X
AD  - Bariatric and Metabolic Institute, Department of General Surgery, Cleveland 
      Clinic, Cleveland, OH.
AD  - Department of Endocrinology, UZ Leuven, Leuven, Belgium.
FAU - Wilson, Rickesha L
AU  - Wilson RL
AD  - Bariatric and Metabolic Institute, Department of General Surgery, Cleveland 
      Clinic, Cleveland, OH.
FAU - Cherla, Deepa V
AU  - Cherla DV
AD  - Bariatric and Metabolic Institute, Department of General Surgery, Cleveland 
      Clinic, Cleveland, OH.
FAU - Tu, Chao
AU  - Tu C
AD  - Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland 
      Clinic, Cleveland, OH.
FAU - Kashyap, Sangeeta R
AU  - Kashyap SR
AD  - Department of Endocrinology, Endocrinology and Metabolism Institute, Cleveland 
      Clinic, Cleveland, OH.
FAU - Cummings, David E
AU  - Cummings DE
AD  - VA Puget Sound Health Care System and UW Medicine Diabetes Institute, University 
      of Washington, Seattle, WA.
FAU - Schauer, Philip R
AU  - Schauer PR
AD  - Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, 
      LA.
FAU - Aminian, Ali
AU  - Aminian A
AUID- ORCID: 0000-0001-5756-9917
AD  - Bariatric and Metabolic Institute, Department of General Surgery, Cleveland 
      Clinic, Cleveland, OH aminiaa@ccf.org.
LA  - eng
SI  - figshare/10.2337/figshare.13166255
GR  - M01 RR018390/RR/NCRR NIH HHS/United States
GR  - R01 DK089547/DK/NIDDK NIH HHS/United States
GR  - U01 DK114156/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20201215
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
SB  - IM
MH  - *Bariatric Surgery
MH  - *Diabetes Mellitus, Type 2/complications
MH  - *Fatty Liver/complications
MH  - *Gastric Bypass
MH  - Humans
MH  - *Obesity, Morbid
MH  - Remission Induction
MH  - Treatment Outcome
PMC - PMC8176204
EDAT- 2020/12/17 06:00
MHDA- 2021/08/21 06:00
PMCR- 2022/02/01
CRDT- 2020/12/16 05:28
PHST- 2020/01/22 00:00 [received]
PHST- 2020/10/29 00:00 [accepted]
PHST- 2020/12/17 06:00 [pubmed]
PHST- 2021/08/21 06:00 [medline]
PHST- 2020/12/16 05:28 [entrez]
PHST- 2022/02/01 00:00 [pmc-release]
AID - dc20-0150 [pii]
AID - 200150 [pii]
AID - 10.2337/dc20-0150 [doi]
PST - ppublish
SO  - Diabetes Care. 2021 Feb;44(2):321-325. doi: 10.2337/dc20-0150. Epub 2020 Dec 15.