Correlation Between Bilirubin And Insulin Sensitivity In Obese Patients With Abnormal Glucose Metabolism

Part ?:Study on the correlation between bilirubin and insulin sensitivity in different population (healthy,obesity,IGR/T2DM obesity)Objective:To investigate the relationship between various bilirubin and insulin sensitivity in different populations(healthy,simple obesity and IGR/T2DM obesity).Methods:A total of 94 eligible subjects who underwent hyperinsulinemic euglycemic clamp(HEC)in the outpatient department and inpatient department of endocrinology of the first affiliated hospital of nanjing medical university from April2014 to February 2018 were collected.The relevant clinical data of the patients were retrospectively analyzed,and according to the body mass index(BMI 28 kg/m~2)and OGTT results,they were divided into three groups:healthy control group(23 cases),obesity group(33 cases)and IGR/T2DM obesity group(38 cases).Body weight,biochemical and metabolic indexes were compared among the three groups.TBIL,DBIL and IBIL were then assessed for correlation wiht FPG,FINS,FC-p,M,ALT,AST,ALP,GGT,TC,TG,HDL and LDL of the patients with IGR/T2DM obesity group.Taking M=4.90 mg/kg·min as the cutoff value,38 patients with IGR/T2DM obesity were divided into those with and without insulin resistance,and correlation analysis was conducted with TBIL,DBIL and IBIL.Multivariate logistic regression analysis was performed with TBIL,DBIL and IBIL to determine the presence of insulin resistance.Results:1.Compared with the obesity group and the healthy control group,the IGR/T2DM obesity group showed significantly higher FPG and lower M,with statistically significant differences(P<0.001).Compared with simple obesity group,TBIL and IBIL in IGR/T2DM obesity group were both increased,and the differences were statistically significant(P<0.05),while the differences in DBIL were not statistically significant(P>0.05).2.TBIL was correlated with FC-p and M value in obese patients with IGR/T2DM(r=-0.330,P=0.043;r=0.325,P=0.046);IBIL was correlated with M value(r=0.324,P=0.047),and there was no correlation among other indicators.3.Correlation analysis was conducted between insulin resistance and TBIL,DBIL and IBIL in 38 patients with IGR/T2DM obesity,and the results showed negative correlation(r=-0.452,P=0.004;r=-0.376,P=0.020;r=-0.500,P=0.001).4.Multivariate logistic regression analysis results suggest that TBIL and IBIL may be independent protective factors of insulin resistance.Conclusion:1.Compared with the simple obesity population,the insulin sensitivity of patients with IGR/T2DM obesity was low,while IBIL and TBIL were high.2.In patients with IGR/T2DM obesity,there is a positive correlation between bilirubin and insulin sensitivity,mainly due to the effect of indirect bilirubin.The total bilirubin and indirect bilirubin were more higher,the insulin sensitivity of patients were more better and the insulin resistance were more lower.3.Serum total bilirubin and serum indirect bilirubin may be independent protective factors of insulin resistance in obese patients with IGR/T2DM.Part ?: Study on the correlation between bilirubin and insulin sensitivity in obese patients with IGR/T2 DM 1 month after bariatric surgeryObjective: To investigate the short-term change characteristics of bilirubin and insulin sensitivity and the correlation between them in obese patients with IGR/T2 DM after bariatric surgery.Methods: Obese patients underwent bariatric surgery in the First Affiliated Hospital of Nanjing Medical University from July 2010 to November 2016 were collected.According to the inclusion criteria,109 patients were included in the study.Body weight,OGTT,insulin sensitivity and biochemical indexes were compared before and1 month after metabolic surgery.The change rates of TBIL,DBIL and IBIL were divided into three parts to compare the body weight,glucose metabolism and biochemical indexes of each group.The bilirubin change rate(TBIL%,DBIL%,IBIL%)at 1 month after surgery was pair-to-pair correlation analysis with the change values of glucose metabolism indexes(FPG,FINS,FC-p,Matsuda Index,HOMA-IR).Multiple linear regression analysis was performed with the change value of Matsuda Index in postoperative 1 month for the dependent variable,age,sex,operation way,?BMI,? OMA-IR,?IBIL% as the independent variabler.Results: 1.Compared with the preoperative period,the average body weight,BMI of the 109 patients 1 month after surgery all decreased significantly.Postoperative OGTT blood glucose decreased significantly at all time points.Matsuda Index significantly increased and HOMA-IR significantly decreased,and TBIL,DBIL and IBIL all increased significantly at 1 month after surgery.The above differences were statistically significant(P<0.001).2.109 patients were divided into three groups according to the cutoff value of IBIL rate of change 14.93% and 54.18%,and the weight,glucose metabolism and biochemical indexes of each group were compared respectively.The results showed that the increase of Matsuda Index was more obvious in the group IBIL% 54.18 compared with the group IBIL% 14.93,and the difference was statistically significant(P<0.05).3.TBIL% was correlated with changes in FINS and FC-p(r=-0.217,P=0.024;r=-0.195,P=0.042),DBIL% was correlated with changes in FINS(r=-0.192,P=0.046),and IBIL% was correlated with changes in FINS,FC-p,Matsuda Index,and HOMA-IR(r=-0.235,P=0.014;r=-0.230,P=0.016;r=-0.230,P=0.016;r=0.195,P=0.042)at 1 month after surgery.4.The results of multiple linear regression analysis suggested that IBIL% was the influencing factor of the change of Matsuda Index 1 month after weight loss in obese patients with IGR/T2 DM.The higher the IBIL%,the higher the Matsuda Index 1month after surgery.Conclusion: 1.Patients with IGR/T2 DM and obesity showed short-term weight loss,increased bilirubin,increased insulin sensitivity and improved glucose metabolism after bariatric surgery,which could improve the glucose metabolism level.2.The greater the increase of the percentage change in indirect bilirubin within the physiological range 1 month after metabolic surgery,and the greater the enhancement in insulin sensitivity.3.Serum indirect bilirubin,which is the main component of total bilirubin,might be a protective factor that enhances insulin sensitivity.Part ?: Study on the correlation between bilirubin and insulin sensitivity in patients with IGR/T2 DM who were followed up for 12 months after bariatric surgeryObjective: To investigate the long-term changes of bilirubin and insulin sensitivity,and the correlation between bilirubin and insulin sensitivity in obese patients with IGR/T2 DM after bariatric surgery.And to investigate the effect of different operation methods on the change of bilirubin.Methods: Obese patients underwent bariatric surgery in the in the First Affiliated Hospital of Nanjing Medical University from July 2010 to November 2016 were collected.A total of 98 patients were included in the study,including 65 patients in the RYGB group and 33 patients in the SG group.The relevant clinical data of the patients were reviewed,and the weight,metabolic and biochemical indexes,changes and trends of all the patients and the two groups before and after surgery at 1 month,3 months,6 months and 12 months were compared respectively.Pair-to-pair correlation analysis was performed on the changes of bilirubin rate(TBIL%,DBIL%,IBIL%)and glucose metabolism index(Hb A1 c,FPG,FINS,HOMA-IR)in all 98 patients and the two groups at 12 months after surgery.Results: 1.The body weight index and glucose metabolism index at 1,3,6 and 12 months after bariatric surgery were significantly lower than those before surgery(P<0.001).2.TBIL and DBIL of the 98 patients were significantly increased at 1,3,6 and12 months after surgery compared with that before surgery,and the difference was statistically significant(P<0.05).There was no significant difference in IBIL between1 and 3 months after surgery and before surgery(P>0.05),and the values at 6,12 months were significantly higher than those before surgery(P<0.05).The 65 patients in RYGB group showed significant increase in TBIL and DBIL at 1,3,6 and 12 months after surgery compared with that before surgery,and the difference was statistically significant(P<0.05).The TBIL,DBIL and IBIL of 33 patients in SG group were significantly increased at 1,3,6 and 12 months compared with those before surgery,and the difference was statistically significant(P<0.05).There was a difference in DBIL changes between the two groups 12 months,and the increase was more higher in RYGB group,and the difference was statistically significant(P=0.006).The changes of IBIL in the two groups were different at 3 and 6 months,and the increase in SG group was more significant(P=0.010,P=0.007).There was no difference in the postoperative trend of total bilirubin and direct bilirubin between the two groups(P>0.05),while the trend of indirect bilirubin was different(P=0.047).3.All the 98 patients and the two groups showed no correlation between the change rate of bilirubin(TBIL%,DBIL%,IBIL%)and the change value of glucose metabolism indexes(Hb A1 c,FPG,FINS,HOMA-IR)at 12 months after surgery.Conclusion: 1.After bariatric surgery,short-term and long-term weight indexes of obese patients with IGR/T2 DM significantly decreased,glucose metabolism improved,and insulin sensitivity increased.Bariatric surgery plays an important role in short-term and long-term improvement of glucose metabolism of obese patients with IGR/T2 DM.2.The change of bilirubin will appear in the short term after bariatric surgery,and it will be increased in the long term.Both of the two methods can lead to the change of bilirubin,but they have different effects on the change trend of indirect bilirubin.