Original articleNitrosative stress but not glycemic parameters correlate with improved neuropathy in nonseverely obese diabetic patients after Roux-Y gastric bypass
Section snippets
Methods
Twenty patients were prospectively enrolled in this study, as previously published [17]. In brief, inclusion criteria comprised insulin-dependent T2DM, a BMI 25–35 kg/m2, preserved insulin-secretion assessed by a glucagon-stimulated C-peptide of>1.5 ng/mL, glycated hemoglobin (HbA1 c)>7% (53 mmol/mol IFCC), and age 18–70 years. The study was approved by the institutional review board and was registered in the German Clinical Study Registry (DRKS00004605). Clinical data after 6 months have
Results
Patient demographic characteristics are shown in Table 1, the NDS, excess weight loss, fasting glucose, and HbA1c results until the 6 month follow-up visit have been published previously. The NDS, fasting glucose, and HbA1c decreased within 6 months [17]. One patient died due to a cholangiocarcinoma. For all the other patients, we had complete follow-up after 12 months. The changes in NDS, glycemic control, BMI, excessive weight loss, and CRP are shown in Table 2. Thus the NDS, fasting glucose,
Discussion
For this cohort of T2DM patients and BMI<35 kg/m2, diabetic neuropathy improved within 3 months and remained improved by 6 months postoperatively [17]. The present analysis adds that RYGB has a persisting positive effect on diabetic neuropathy for at least twelve months, and that nitrosative, carbonyl, and oxidative stress are rapidly improved by RYGB. These effects strongly correlated with an improvement in neuropathic deficits, which indicates that nitrosative, carbonyl, and oxidative stress
Conclusion
In summary, we found that diabetic neuropathy improved strongly and lastingly over a twelve month postoperative period in patients with long-standing T2DM after RYGB. Furthermore, our data suggest that nitrosative, carbonyl, and oxidative stress may play a pivotal role in the underlying mechanisms of diabetic neuropathy reversal following metabolic surgery. Importantly, the improvement of T2DM neuropathy seems to be independent of glycemic control and weight loss. Besides pathogenetic insights,
Disclosures
There was no financial support for this study and there are no conflicts of interest.
The study is registered at the German Clinical Study Registry (DRKS00004605) (www.drks.de).
Author contributions
B.P.M.: designed the study, critically reviewed and edited the manuscript, A.T.B.: designed the study, conducted the experiments, researched the data and wrote the manuscript, T.F.: conducted the experiments and researched the data, L.F.: critically reviewed and edited the manuscript. M.W.B.: critically reviewed and edited the manuscript, P.P.N.: contributed to discussion, and critically reviewed and edited the manuscript.
Acknowledgment
We thank Elizabeth Corrao, freelance medical editor, for the native English editing of this manuscript.
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These 2 authors contributed equally.