Change In The Iron Status Following Gastric Bypass In Patients With Type2Diabetes

Objective:To observe the changes of serum iron, ferritin, hepcidin and hemoglobin levels before and after gastrointestinal bypass surgery in patients with type2diabetes (T2DM) and to explore the relationship between the postoperative changes in iron metabolic and the improvement of diabetes.Methods:Plasma levels of weight,BMI,WHR,fasting glucose(FBG), fasting insulin(FINS), glycated hemoglobin(HbA1C), hemoglobin(Hb),lipids and gastrointestinal endoscopy were measured in52patients with type2diabetes before and after gastrointestinal bypass surgery. Preoperative and postoperative levels of serum iron, ferritin and hepcidin were measured by Enzyme-linked immunosorbent assay (ELISA).Results:(1) Significant reductions in weight, BMI, WHR were observed after gastrointestinal bypass surgery. Likewise, postoperative fasting C-peptide, HOMA-IR and the indicators of lipid metabolism(P <0.01)were also reduced in comparision to that preoperatively. The difference of HbA1c and FBS before and after surgery was also statistically significant (P<0.001).(2) Significant reduction in postoperative hemoglobin level (126.0±19.2vs138.9±16.9g/l;P<0.001) was noted. Preoperatively, anemia was present in5.77%of patients (3men) only whereas anemia developed in21.15%of patients (8men and3women) post-operatively. Gastrointestinal endoscopy revealed that there was a significant increment in the presence of gastrointestinal ulcers postoperatively (42.31%), compared with that preoperatively(23.08%).(3) No statistically significant change in the serum iron levels was noted postoperatively(3.05±2.60vs2.96±2.86mg/1;P>0.05). However,the levels of ferritin (224.9±207.1vs422.2±296.5ug/1) and hepcidin (18.88±5.28vs23.87±5.98ng/ml) were decreased compared to the preoperative levels, and the difference was statistically significant(P<0.001).(4) Correlation analysis showed that postoperative the changes of serum iron was correlated with the changes of hepcidin, BMI, HOMA-IR, weight and C-Peptide, and the correlation coefficient r values were0.325(P=0.019),0.371(P=0.007),-0.304(P=0.034),0.358(P=0.009),0.461(P=0.001)respectively.Conclusion:There was a reduction in the postoperative levels of ferritin and hepcidin, but no significant change in serum iron level, compared to that preoperatively.