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. 2016 May 3;11(5):e0154211.
doi: 10.1371/journal.pone.0154211. eCollection 2016.

Bariatric Surgery Restores Cardiac and Sudomotor Autonomic C-Fiber Dysfunction towards Normal in Obese Subjects with Type 2 Diabetes

Carolina M Casellini  1 , Henri K Parson  1 , Kim Hodges  1 , Joshua F Edwards  1 , David C Lieb  1 , Stephen D Wohlgemuth  2 , Aaron I Vinik  1
Affiliations

Bariatric Surgery Restores Cardiac and Sudomotor Autonomic C-Fiber Dysfunction towards Normal in Obese Subjects with Type 2 Diabetes

Carolina M Casellini et al. PLoS One. .

Abstract

Objective: The aim was to evaluate the impact of bariatric surgery on cardiac and sudomotor autonomic C-fiber function in obese subjects with and without Type 2 diabetes mellitus (T2DM), using sudorimetry and heart rate variability (HRV) analysis.

Method: Patients were evaluated at baseline, 4, 12 and 24 weeks after vertical sleeve gastrectomy or Roux-en-Y gastric bypass. All subjects were assessed using SudoscanTM to measure electrochemical skin conductance (ESC) of hands and feet, time and frequency domain analysis of HRV, Neurologic Impairment Scores of lower legs (NIS-LL), quantitative sensory tests (QST) and sural nerve conduction studies.

Results: Seventy subjects completed up to 24-weeks of follow-up (24 non-T2DM, 29 pre-DM and 17 T2DM). ESC of feet improved significantly towards normal in T2DM subjects (Baseline = 56.71±3.98 vs 12-weeks = 62.69±3.71 vs 24-weeks = 70.13±2.88, p<0.005). HRV improved significantly in T2DM subjects (Baseline sdNN (sample difference of the beat to beat (NN) variability) = 32.53±4.28 vs 12-weeks = 44.94±4.18 vs 24-weeks = 49.71±5.19, p<0,001 and baseline rmsSD (root mean square of the difference of successive R-R intervals) = 23.88±4.67 vs 12-weeks = 38.06±5.39 vs 24-weeks = 43.0±6.25, p<0.0005). Basal heart rate (HR) improved significantly in all groups, as did weight, body mass index (BMI), percent body fat, waist circumference and high-density lipoprotein (HDL). Glycated hemoglobin (HbA1C), insulin and HOMA2-IR (homeostatic model assessment) levels improved significantly in pre-DM and T2DM subjects. On multiple linear regression analysis, feet ESC improvement was independently associated with A1C, insulin and HOMA2-IR levels at baseline, and improvement in A1C at 24 weeks, after adjusting for age, gender and ethnicity. Sudomotor function improvement was not associated with baseline weight, BMI, % body fat or lipid levels. Improvement in basal HR was also independently associated with A1C, insulin and HOMA2-IR levels at baseline.

Conclusion: This study shows that bariatric surgery can restore both cardiac and sudomotor autonomic C-fiber dysfunction in subjects with diabetes, potentially impacting morbidity and mortality.

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Conflict of interest statement

Competing Interests: The study was funded by Impeto Medical Inc. San Diego, California. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Changes in Anthropometric measures in the 3 groups after 24 weeks.
Data presented as mean ± SEM. p = NS (ANOVA between group comparison at 24 weeks). DM = diabetes mellitus
Fig 2
Fig 2. Changes in Anthropometric measures 24 weeks post roux-en-y gastric bypass or vertical sleeve gastrectomy.
Data presented as mean ± SEM. p = NS (ANOVA between group comparison at 24 weeks). RYGB = roux-en-Y gastric bypass; VSG = vertical sleeve gastrectomy
Fig 3
Fig 3. Change in primary endpoints 4, 12 and 24 weeks after bariatric surgery.
*Repeated measures MANOVA. DB = deep breathing maneuver; DM = diabetes mellitus; ESC = electrochemical skin conductance; HR = heart rate; rmsSD = root mean square of the difference of successive R-R intervals; sdNN = sample difference of the beat to beat (NN) variability
Fig 4
Fig 4. Changes in Sudomotor and Cardiac autonomic measures in the 3 groups.
Data presented as mean ± SEM *p<0.05 (ANOVA between group comparison at 24 weeks). DB = deep breathing maneuvers; DM = diabetes mellitus; ESC = electrochemical skin conductance; HR = heart rate; HRV = heart rate variability; rmsSD = root mean square of the difference of successive R-R intervals; sdNN = sample difference of the beat to beat (NN) variability
Fig 5
Fig 5. Correlations between improvements in heart rate with improvements in HRV measures 24 weeks after bariatric surgery.
DB = deep breathing maneuvers; HR = heart rate; HRV = heart rate variability; rmsSD = root mean square of the difference of successive R-R intervals; sdNN = sample difference of the beat to beat (NN) variability
See this image and copyright information in PMC

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