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08-20-2019 | Metabolic surgery | News

Succinate levels may predict diabetes remission after bariatric surgery

medwireNews: Individuals with lower preoperative levels of serum succinate are more likely to achieve remission of type 2 diabetes after bariatric surgery than those with higher levels of the metabolite, study results suggest.

“Our findings underscore the importance of circulating metabolites as potentially valuable predictive factors of diabetes remission after bariatric surgery,” and point to succinate as “a new variable to reflect metabolic disease severity,” say Sonia Fernández-Veledo (Hospital Universitari de Tarragona Joan XXIII, Spain) and co-researchers.

Moreover, the team found that the association between the type of surgery performed and diabetes outcome may be influenced by succinate levels, suggesting that the metabolite “could be a useful metric to determine the best-suited surgical procedure.”

The investigators evaluated the association between baseline succinate levels and postsurgical outcomes among 45 obese people with type 2 diabetes and an average baseline BMI of 39.5 kg/m2 who took part in a randomized trial comparing Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic greater curvature plication.

As reported in Diabetes Care, median levels of circulating succinate prior to surgery were significantly lower among the 23 patients who achieved diabetes remission (glycated hemoglobin [HbA1c] <6% and fasting plasma glucose <100 mg/dL in the absence of drug therapy or ongoing procedures for ≥1 year) compared with the 22 individuals who did not, at 47.8 µmol/L versus 64.1 µmol/L.

In a logistic regression model including variables such as age, sex, HbA1c, and surgery type, people with baseline succinate levels below the cutoff of 48.1 µmol/L had a significant 11.3-fold increased likelihood of achieving diabetes remission at 1 year than those with higher levels. Surgery type was also a significant predictor of diabetes outcome.

Using this model, named DiaSuc, area under the receiver operating characteristic curve analysis demonstrated that baseline succinate levels at a cutoff of 48.1 µmol/L correctly distinguished between people who did and did not achieve diabetes remission on 89.9% of occasions.

The investigators remark that the predictive ability of the DiaSuc model “significantly improves upon type 2 diabetes prediction” achieved by the ABCD and the AdDiaRem scores, which have predictive abilities of 61.0% and 72.8%, respectively.

The model performed well in an independent validation cohort of 55 patients, correctly identifying individuals with or without diabetes remission on 72.9% of occasions, but the performance of the DiaSuc model was not tested against the other scores in the validation cohort.

Fernández-Veledo et al also assessed the association between surgery type and diabetes outcome for people with different succinate levels. Among patients with levels of 48.1 µmol/L or higher, those who underwent malabsorptive surgery (ie, gastric bypass) had significantly higher rates of diabetes remission at 1 year than those who underwent one of the restrictive techniques (66.7 vs 22.7%), but no such association was seen among individuals with succinate levels below the cutoff.

The researchers conclude that “further randomized controlled studies will be needed as a next step to establish the use of succinate as a clinical decision support tool for selecting the best-suited bariatric surgical procedures.”

By Claire Barnard

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Diabetes Care 2019; doi:10.2337/dc19-0114

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