Restoration of normal glucose tolerance in severely obese patients after bilio-pancreatic diversion: Role of insulin sensitivity and beta cell function

A. Mari, M. Manco, C. Guidone, G. Nanni, M. Castagneto, G. Mingrone, E. Ferrannini

Research output: Contribution to journalArticle

Abstract

Aims/hypothesis: The aim of this study was to analyse the mechanisms underlying the improvement in glucose tolerance seen in morbidly obese patients undergoing bilio-pancreatic diversion (BPD). Subjects and methods: We evaluated glucose tolerance (by OGTT), insulin sensitivity (euglycaemic-hyperinsulinaemic clamp and the OGTT index OGIS) and beta cell function (OGTT modelling analysis) in 32 morbidly obese (BMI=52± 7 kg/m 2, mean±SD) patients (12 with NGT, 9 with IGT and 11 with type 2 diabetes), before and after BPD, and in 22 lean control subjects. Patients were studied before and from 7 days to 60 months after surgery. Results: BPD improved glucose tolerance in all subjects, who after surgery all had normal glucose tolerance. Insulin sensitivity was restored to normal levels in all subjects (pre-BPD 341±79 ml min -1 m -2, post-BPD 511±57 ml min -1 m -2, lean 478±49 ml min -1 m -2). The insulin sensitivity change was detectable within 10 days of BPD. At baseline, beta cell sensitivity to glucose was impaired in diabetic subjects (25 [18] pmol min -1 m -2 l mmol -1, median [interquartile range]) compared with lean subjects (82 [98]; p≤0.05). After BPD, beta cell glucose sensitivity showed a tendency towards improvement but remained impaired in diabetic subjects (30 [62]; p2=0.67, partial r=-0.76 and -0.41, respectively). NEFAs, leptin and adiponectin were related to insulin sensitivity but could not explain the early improvement. Conclusions/interpretation: Following BPD, glucose tolerance was restored mainly as a result of a rapid and large improvement in insulin sensitivity.

Original languageEnglish
Pages (from-to)2136-2143
Number of pages8
JournalDiabetologia
Volume49
Issue number9
DOIs
Publication statusPublished - Sep 2006

Keywords

  • Bariatric surgery
  • Beta cell function
  • Bilio-pancreatic diversion
  • Glucose tolerance
  • Insulin resistance
  • Insulin secretion
  • Insulin sensitivity
  • Morbid obesity
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Fingerprint Dive into the research topics of 'Restoration of normal glucose tolerance in severely obese patients after bilio-pancreatic diversion: Role of insulin sensitivity and beta cell function'. Together they form a unique fingerprint.

  • Cite this