M-index as a predictor of glycemia normalization in T2D patients early after bariatric surgery

Abstract

There are several models for predicting remission of type 2 diabetes mellitus (T2D) a year after bariatric surgery — DiaRem, ABSD, IMS, etc. However, these models cannot be used to predict the early normalization of glycemia (within a few months after surgery). These models also do not include the assessment of insulin resistance (IR).AIM. To assess the effect of insulin resistance on the development of remission of T2D after bariatric surgery.METHODS: The study included 42 patients with T2D and severe obesity, who underwent bariatric surgery. Baseline assessment included hyperinsulinemic euglycemic clamp test (with the determination of the M-index (mg/kg/min), and evaluation of HOMA-IR index. Glycemia normalization was determined by self-monitoring (<6.1 mmol/l at fasting state and <7.8 mmol/l 2 hours after meals) as well as by HbA1c (<6.5%, starting 3 months after surgery). We used ROC analysis to determine the possibility of using IR indicators in predicting of the normalization of glycemia after bariatric surgery. The cut off value was determined using the Yuden criterion.RESULTS: All patients were severely insulin resistant. The median M-index before surgery was 1.535 mg/kg/min, the HO-MA-IR index was 10.0. During 1 year after surgery the increasing number of patients reached normal glycemia: 7 (16.7%) patients in 1 month, 22 (52.4%) patients after 3 months, 31 (73.8%) patients after 6 months, 35 (83.3%) patients after 12 months. In ROC analysis the optimal threshold the M-index was 1.876 mg/kg/min.CONCLUSION: The value of the M-index > 1.876 mg/kg/min can be used to predict the glycemia normalization early after bariatric surgery.

Keywords

• diabetes mellitus
• bariatric surgery
• obesity
• diabetes remission