Type 2 diabetes mellitus remission in sleeve gastrectomy patients: Role of enteroendocrine response and serum citrulline and I-FABP levels

Am J Surg. 2024 Oct:236:115782. doi: 10.1016/j.amjsurg.2024.115782. Epub 2024 May 28.

Abstract

Introduction: This prospective cohort study examines the relationship between post-sleeve gastrectomy (SG) weight loss and serum citrulline, I-FABP levels, and the I-FABP/citrulline ratio in obese patients, alongside the correlation with type 2 diabetes mellitus (T2DM) remission.

Methods: 88 participants were enrolled, including 48 undergoing SG and 21 with T2DM. 40 healthy individuals served as controls. Preoperative and 1-year postoperative assessments included citrulline, I-FABP, glucose, insulin, HbA1c, and C peptide levels.

Results: Significant weight loss and T2DM remission (11/21) were observed post-SG. Preoperatively, patients had low citrulline and high I-FABP levels, which normalized postoperatively. A positive correlation was found between the I-FABP/citrulline ratio and weight, BMI, glucose, insulin, and C peptide levels.

Conclusion: SG not only induces enterocyte dysfunction and mass recovery but also may facilitate T2DM remission and alleviate obesity-related effects on the enteroendocrine system. These findings highlight the potential beneficial effects of SG on enteroendocrine function in obese patients.

Keywords: Citrulline; I-FABP; Inflammation; Obesity; Type 2 diabetes.

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • Blood Glucose / metabolism
  • Case-Control Studies
  • Citrulline* / blood
  • Diabetes Mellitus, Type 2* / blood
  • Fatty Acid-Binding Proteins
  • Female
  • Gastrectomy* / methods
  • Humans
  • Male
  • Middle Aged
  • Obesity, Morbid / blood
  • Obesity, Morbid / surgery
  • Prospective Studies
  • Remission Induction
  • Weight Loss / physiology

Substances

  • Citrulline
  • FABP1 protein, human
  • Blood Glucose
  • Fatty Acid-Binding Proteins