Mechanisms of recovery from type 2 diabetes after malabsorptive bariatric surgery

Caterina Guidone, Melania Manco, Elena Valera-Mora, Amerigo Iaconelli, Donatella Gniuli, Andrea Mari, Giuseppe Nanni, Marco Castagneto, Menotti Calvani, Geltrude Mingrone

Research output: Contribution to journalArticlepeer-review

Abstract

Currently, there are no data in the literature regarding the pathophysiological mechanisms involved in the rapid resolution of type 2 diabetes after bariatric surgery, which was reported as an additional benefit of the surgical treatment for morbid obesity. With this question in mind, insulin sensitivity, using euglycemic-hyperinsulinemic clamp, and insulin secretion, by the C-peptide deconvolution method after an oral glucose load, together with the circulating levels of intestinal incretins and adipocytokines, have been studied in 10 diabetic morbidly obese subjects before and shortly after biliopancreatic diversion (BPD) to avoid the weight loss interference. Diabetes disappeared 1 week after BPD, while insulin sensitivity (32.96 ± 4.3 to 65.73 ± 3.22 μmol·kg fat-free mass-1·min -1 at 1 week and to 64.73 ± 3.42 μmol·kg fat-free mass-1·min-1 at 4 weeks; P <0.0001) was fully normalized. Fasting insulin secretion rate (148.16 ± 20.07 to 70.0.2 ± 8.14 and 83.24 ± 8.28 pmol/min per m2; P <0.01) and total insulin output (43.76 ± 4.07 to 25.48 ± 1.69 and 30.50 ± 4.71 nmol/m2; P <0.05) dramatically decreased, while a significant improvement in β-cell glucose sensitivity was observed. Both fasting and glucose-stimulated gastrointestinal polypeptide (13.40 ± 1.99 to 6.58 ± 1.72 pmol/l at 1 week and 5.83 ± 0.80 pmol/l at 4 weeks) significantly (P <0.001) decreased, while glucagon-like peptide 1 significantly increased (1.75 ± 0.16 to 3.42 ± 0.41 pmol/l at 1 week and 3.62 ± 0.21 pmol/l at 4 weeks; P <0.001). BPD determines a prompt reversibility of type 2 diabetes by normalizing peripheral insulin sensitivity and enhancing β-cell sensitivity to glucose, these changes occurring very early after the operation. This operation may affect the enteroinsular axis function by diverting nutrients away from the proximal gastrointestinal tract and by delivering incompletely digested nutrients to the ileum.

Original languageEnglish
Pages (from-to)2025-2031
Number of pages7
JournalDiabetes
Volume55
Issue number7
DOIs
Publication statusPublished - Jul 2006

Keywords

  • AUC, area under the curve
  • BPD, biliopancreatic diversion
  • FFM, fat-free mass
  • GIP, gastrointestinal polypeptide
  • GLP-1, glucagon-like peptide 1
  • OGTT, oral glucose tolerance test

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

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