Patients with prediabetes improve insulin resistance after surgery for primary hyperparathyroidism.

Journal

Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347

Informations de publication

Date de publication:
Jan 2024
Historique:
received: 05 02 2023
revised: 14 03 2023
accepted: 05 04 2023
pubmed: 20 11 2023
medline: 20 11 2023
entrez: 19 11 2023
Statut: ppublish

Résumé

The objective of this study was to evaluate the evolution of insulin resistance at 12 months after parathyroidectomy for primary hyperparathyroidism according to the preoperative severity of glucose metabolism abnormalities. Observational study of patients who underwent parathyroidectomy between 2016 and 2021. Prediabetes and insulin resistance were defined as fasting glucose ≥1.00 g/L (American Diabetes Association) and homeostatic model assessment of insulin resistance >2.5, respectively. A total of 231 patients were included. Preoperatively, 75 patients (32%) had prediabetes, and 108 patients (47%) had insulin resistance. At 12 months postoperative, homeostatic model assessment of insulin resistance values significantly decreased in patients with prediabetes (-0.69; P = .04) and in patients with insulin resistance (-0.85; P < .001). In patients with prediabetes, 48/75 (64%) decreased their insulin resistance, including 15/48 (31%) with normalization of fasting glucose. In multivariate analysis, preoperative prediabetes (1.82, 1.03-3.21; P = .037) or preoperative homeostatic model assessment of insulin resistance >2.5 (3.90, 2.23-6.75; P < .001) remained independent predictors for insulin resistance reduction observed between preoperative and 12 months postoperative. Parathyroidectomy is more likely to reduce insulin resistance in patients with primary hyperparathyroidism and prediabetes or in patients with higher preoperative homeostatic model assessment of insulin resistance values. These data support the use of the preoperative prediabetes criterion in addition to the international workshop criteria for parathyroidectomy to better select patients for surgery.

Sections du résumé

BACKGROUND BACKGROUND
The objective of this study was to evaluate the evolution of insulin resistance at 12 months after parathyroidectomy for primary hyperparathyroidism according to the preoperative severity of glucose metabolism abnormalities.
METHODS METHODS
Observational study of patients who underwent parathyroidectomy between 2016 and 2021. Prediabetes and insulin resistance were defined as fasting glucose ≥1.00 g/L (American Diabetes Association) and homeostatic model assessment of insulin resistance >2.5, respectively.
RESULTS RESULTS
A total of 231 patients were included. Preoperatively, 75 patients (32%) had prediabetes, and 108 patients (47%) had insulin resistance. At 12 months postoperative, homeostatic model assessment of insulin resistance values significantly decreased in patients with prediabetes (-0.69; P = .04) and in patients with insulin resistance (-0.85; P < .001). In patients with prediabetes, 48/75 (64%) decreased their insulin resistance, including 15/48 (31%) with normalization of fasting glucose. In multivariate analysis, preoperative prediabetes (1.82, 1.03-3.21; P = .037) or preoperative homeostatic model assessment of insulin resistance >2.5 (3.90, 2.23-6.75; P < .001) remained independent predictors for insulin resistance reduction observed between preoperative and 12 months postoperative.
CONCLUSION CONCLUSIONS
Parathyroidectomy is more likely to reduce insulin resistance in patients with primary hyperparathyroidism and prediabetes or in patients with higher preoperative homeostatic model assessment of insulin resistance values. These data support the use of the preoperative prediabetes criterion in addition to the international workshop criteria for parathyroidectomy to better select patients for surgery.

Identifiants

DOI: 10.1016/j.surg.2023.04.072 PMID: 37981555
pubmed: 37981555
pii: S0039-6060(23)00727-4
doi: 10.1016/j.surg.2023.04.072
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

180-186

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Auteurs

Claire Nomine-Criqui (C)

University of Lorraine, CHU Nancy - Hospital Brabois Adultes, Department of Surgery (CVMC), Unit of Endocrine and Metabolic Surgery (7ème étage), Nancy, France; University of Lorraine, INSERM NGERE / U1256, "Nutrition, Genetics, Environmental Risks," Faculty of Medicine, Nancy, France.

Florence Bihain (F)

University of Lorraine, CHU Nancy - Hospital Brabois Adultes, Department of Surgery (CVMC), Unit of Endocrine and Metabolic Surgery (7ème étage), Nancy, France; University of Lorraine, INSERM NGERE / U1256, "Nutrition, Genetics, Environmental Risks," Faculty of Medicine, Nancy, France.

Phi-Linh Nguyen-Thi (PL)

University of Lorraine, CHU Nancy, Department of Medical Informatics and Evaluation, Nancy, France.

Nicolas Scheyer (N)

University of Lorraine, CHU Nancy, Department of Endocrinology, Diabetology and Nutrition (EDN), Nancy, France.

Léa Demarquet (L)

University of Lorraine, CHU Nancy, Department of Endocrinology, Diabetology and Nutrition (EDN), Nancy, France.

Marc Klein (M)

University of Lorraine, CHU Nancy, Department of Endocrinology, Diabetology and Nutrition (EDN), Nancy, France.

Bruno Guerci (B)

University of Lorraine, CHU Nancy, Department of Endocrinology, Diabetology and Nutrition (EDN), Nancy, France.

Laurent Brunaud (L)

University of Lorraine, CHU Nancy - Hospital Brabois Adultes, Department of Surgery (CVMC), Unit of Endocrine and Metabolic Surgery (7ème étage), Nancy, France; University of Lorraine, INSERM NGERE / U1256, "Nutrition, Genetics, Environmental Risks," Faculty of Medicine, Nancy, France. Electronic address: l.brunaud@chru-nancy.fr.

Classifications MeSH