Biphasic changes in angiopoietin-like 8 level after laparoscopic sleeve gastrectomy and type 2 diabetes remission during a 1-year follow-up

Background: Angiopoietin-like 8 (ANGPTL8) a hepatic protein, is implicated by several studies with a role in promoting pancreatic β-cell proliferation and improving glucose tolerance. Although a matter of controversy, a growing number of reports support ANGPTL8's potential, yet unclear, role in type 2 diabetes (T2D).

Objectives: To examine changes in fasting ANGPTL8 level in people with morbid obesity, with or without diabetes after laparoscopic sleeve gastrectomy (LSG) in a 1-year prospective study.

Setting: Dasman Diabetes Institute, government, and private hospitals, Kuwait.

Methods: Fasting serum ANGPTL8 was measured by enzyme-linked immunosorbent assay at baseline in participants with morbid obesity, 17 with diabetes and 23 without diabetes, and in healthy weight participants, 19 with and 15 without diabetes, during 1 year post-LSG in participants with morbid obesity.

Results: At baseline, people with T2D had higher ANGPTL8 level, (morbid obese, mean ± standard error of the mean; 1415 ± 196.4 pg/mL, and healthy weight, 2231 ± 328.1 pg/mL), compared with individuals without T2D (morbid obese, 876 ± 155.0 pg/mL, and healthy weight controls 868.9 ± 218.7 pg/mL). In participants with diabetes and morbid obesity, T2D remission occurred 15 days post-LSG, defined by a sustained reduced fasting blood glucose levels <6.9 mmol/L. In this group, the 1-year post-LSG measurement of ANGPTL8 showed unique biphasic changes, first a prominent elevation (day 60, 3336 ± 916.5 pg/mL, P < .01), followed by a gradual decrease to reach almost the baseline level (day 360, 1184 ± 119.3 pg/mL).

Conclusion: Elevated baseline ANGPTL8 in participants with diabetes at baseline reflected a link to T2D. Interestingly, the unique biphasic pattern of change in fasting ANGPTL8 post-LSG, occurred only in people with diabetes, suggesting ANGPTL8's potential role in T2D remission.