A influência de polimorfismo de genes associados a remissão do Diabetes Tipo II, em pacientes operados de cirurgia bariátrica e metabólica pela técnica de by pass gástrico em Y-de-Roux

Abstract

Introduction: Obesity is the main risk factor for the development of type 2 diabetes mellitus (T2DM), characterized by a progressive loss of pancreatic function, resulting from genetic and environmental changes. Among the genetic changes are variants in key genes responsible for glycemic homeostasis, including GLP1R and TCF7L2. The genetic dysfunction of these genes decreases insulin secretion by β-pancreatic cells, influencing glycemic control. Objective: To evaluate the influence of genetic polymorphisms on the remission of type II diabetes in patients undergoing bariatric and metabolic surgery using the Roux-en-Y gastric bypass technique. Methodology: The research was approved by the ethics and research committee under number 6.158.558 and included a total of 70 patients who underwent bariatric surgery using the bypass technique. Two blood samples were collected, one for laboratory analyses (glucose, cholesterol, triglycerides, glycated hemoglobin, C-peptide) and another for genetic polymorphism analyses. Genomic DNA was extracted using the phenol-chloroform protocol and subsequently analyzed for quantification, purity, and integrity of the extracted samples. For polymorphism analysis, real-time PCR (RT-qPCR) was performed with specific Taqman probes on the ABI 7500 equipment. Statistical analyses were performed using the SPSS 29.0 program. Student's t-test and Spearman's correlation were used to evaluate clinical and biochemical factors. Fisher's exact test and Chi-square were used to analyze the correlation of the presence of variants. Significant values were considered with a p-value ≤ 0.05. Results: Regarding the rs10305420 polymorphism of the GLP1R gene, this variant decreases proportional weight loss over the years and increases glycated hemoglobin after bariatric surgery (p-value = 0.04). The rs7903146 polymorphism of the TCF7L2 gene influences glycated hemoglobin levels, increasing it after gastric bypass (p-value = 0.036). Conclusion: The rs10305420 variant of the GLP1R gene decreases proportional weight loss over the years and increases glycated hemoglobin A1C fraction; and the rs7903146 variant of the TCF7L2 gene in the presence of the T allele also influences the outcome of bariatric and metabolic surgery using the Roux-en-Y gastric bypass technique, increasing the glycated hemoglobin A1C fraction postoperatively and decreasing the remission of type 2 diabetes in patients undergoing this surgical procedure.