Influence of glucometric ‘dynamical’ variables on duodenal-jejunal bypass liner (DJBL) anthropometric and metabolic outcomes
Ana Colás
Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
Search for more papers by this authorManuel Varela
Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
Search for more papers by this authorMilos Mraz
Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
Search for more papers by this authorDaniel Novak
Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
Search for more papers by this authorDavid Cuesta-Frau
Technological Institute of Informatics, Universitat Politècnica de València, Alcoi, Spain
Search for more papers by this authorLuis Vigil
Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
Search for more papers by this authorMarek Benes
Hepatogastroenterology Department, Transplantation Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Search for more papers by this authorTerezie Pelikanova
Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Search for more papers by this authorMartin Haluzik
Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
Laboratory of Experimental Diabetology, Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Search for more papers by this authorVaclav Burda
Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
Search for more papers by this authorCorresponding Author
Borja Vargas
Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
Correspondence
Borja Vargas, Department of Internal Medicine, Hospital Universitario de Móstoles, Calle Río Júcar s/n. 28935 Móstoles, Madrid, Spain.
Email: [email protected]
Search for more papers by this authorAna Colás
Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
Search for more papers by this authorManuel Varela
Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
Search for more papers by this authorMilos Mraz
Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
Search for more papers by this authorDaniel Novak
Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
Search for more papers by this authorDavid Cuesta-Frau
Technological Institute of Informatics, Universitat Politècnica de València, Alcoi, Spain
Search for more papers by this authorLuis Vigil
Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
Search for more papers by this authorMarek Benes
Hepatogastroenterology Department, Transplantation Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Search for more papers by this authorTerezie Pelikanova
Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Search for more papers by this authorMartin Haluzik
Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
Laboratory of Experimental Diabetology, Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Search for more papers by this authorVaclav Burda
Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
Search for more papers by this authorCorresponding Author
Borja Vargas
Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
Correspondence
Borja Vargas, Department of Internal Medicine, Hospital Universitario de Móstoles, Calle Río Júcar s/n. 28935 Móstoles, Madrid, Spain.
Email: [email protected]
Search for more papers by this authorFunding information: Research Center for Informatics, Grant/Award Number: CZ.02.1.01/0.0/0.0/16_019/0000765; Biomedical data acquisition, processing and visualization, Grant/Award Number: SGS19/171/OHK3/3T/13; MH CZ – DRO (“IKEM, IN 00023001”); RVO VFN64165
Abstract
Background
The endoscopically implanted duodenal-jejunal bypass liner (DJBL) is an attractive alternative to bariatric surgery for obese diabetic patients. This article aims to study dynamical aspects of the glycaemic profile that may influence DJBL effects.
Methods
Thirty patients underwent DJBL implantation and were followed for 10 months. Continuous glucose monitoring (CGM) was performed before implantation and at month 10. Dynamical variables from CGM were measured: coefficient of variation of glycaemia, mean amplitude of glycaemic excursions (MAGE), detrended fluctuation analysis (DFA), % of time with glycaemia under 6.1 mmol/L (TU6.1), area over 7.8 mmol/L (AO7.8) and time in range. We analysed the correlation between changes in both anthropometric (body mass index, BMI and waist circumference) and metabolic (fasting blood glucose, FBG and HbA1c) variables and dynamical CGM-derived metrics and searched for variables in the basal CGM that could predict successful outcomes.
Results
There was a poor correlation between anthropometric and metabolic outcomes. There was a strong correlation between anthropometric changes and changes in glycaemic tonic control (∆BMI-∆TU6.1: rho = − 0.67, P < .01) and between metabolic outcomes and glycaemic phasic control (∆FBG-∆AO7.8: r = .60, P < .01). Basal AO7.8 was a powerful predictor of successful metabolic outcome (0.85 in patients with AO7.8 above the median vs 0.31 in patients with AO7.8 below the median: Chi-squared = 5.67, P = .02).
Conclusions
In our population, anthropometric outcomes of DJBL correlate with improvement in tonic control of glycaemia, while metabolic outcomes correlate preferentially with improvement in phasic control. Assessment of basal phasic control may help in candidate profiling for DJBL implantation.
CONFLICT OF INTEREST
No competing financial interests exist.
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