Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patients

Immonen, Heidi; Hannukainen, Jarna C.; Iozzo, Patricia; Soinio, Minna; Salminen, Paulina; Saunavaara, Virva; Borra, Ronald; Parkkola, Riitta; Mari, Andrea; Lehtimäki, Terho; Pham, Tam; Laine, Jukka; Kärjä, Vesa; Pihlajamäki, Jussi; Nelimarkka, Lassi; Nuutila, Pirjo

doi:10.1016/j.jhep.2013.09.012

Cited by 90 publications

(58 citation statements)

References 27 publications

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“…The similarity in change in liver triacylglycerol and hepatic insulin sensitivity in both groups was striking. In NGT, endogenous glucose production falls after bariatric surgery when baseline liver triacylglycerol is high (32). Individual differences in susceptibility to the adverse metabolic effects of intrahepatic fat are implied by the range of baseline liver triacylglycerol in the group with T2DM.…”

Section: Discussionmentioning

confidence: 99%

Weight Loss Decreases Excess Pancreatic Triacylglycerol Specifically in Type 2 Diabetes

et al. 2015

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OBJECTIVEThis study determined whether the decrease in pancreatic triacylglycerol during weight loss in type 2 diabetes mellitus (T2DM) is simply reflective of whole-body fat or specific to diabetes and associated with the simultaneous recovery of insulin secretory function. RESEARCH DESIGN AND METHODSIndividuals listed for gastric bypass surgery who had T2DM or normal glucose tolerance (NGT) matched for age, weight, and sex were studied before and 8 weeks after surgery. Pancreas and liver triacylglycerol were quantified using inphase, out-of-phase MRI. Also measured were the first-phase insulin response to a stepped intravenous glucose infusion, hepatic insulin sensitivity, and glycemic and incretin responses to a semisolid test meal. RESULTSWeight loss after surgery was similar (NGT: 12.8 6 0.8% and T2DM: 13.6 6 0.7%) as was the change in fat mass (56.7 6 3.3 to 45.4 6 2.3 vs. 56.6 6 2.4 to 43.0 6 2.4 kg). Pancreatic triacylglycerol did not change in NGT (5.1 6 0.2 to 5.5 6 0.4%) but decreased in the group with T2DM (6.6 6 0.5 to 5.4 6 0.4%; P = 0.007). Firstphase insulin response to a stepped intravenous glucose infusion did not change in (P = 0.005). No differential effect of incretin secretion was observed after gastric bypass, with more rapid glucose absorption bringing about equivalently enhanced glucagon-like peptide 1 secretion in the two groups. CONCLUSIONSThe fall in intrapancreatic triacylglycerol in T2DM, which occurs during weight loss, is associated with the condition itself rather than decreased total body fat.Type 2 diabetes mellitus (T2DM) has reached epidemic proportions, affecting 9.2% of the U.S. population and costing the country $322 billion in 2012 (1). The condition is widely recognized to be caused by a combination of insulin resistance and insulin secretory failure. However, insulin resistance alone does not cause blood glucose to rise (2), and T2DM occurs only when the acute insulin response of pancreatic b-cells becomes inadequate to control blood glucose (3,4). The etiologic process underlying this is still uncertain. Inhibition by excess intracellular fatty acids or their metabolites is a potential mechanism (5-7). We have previously demonstrated in people with T2DM that weight loss over 8 weeks can normalize the acute insulin response and

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Section: Discussionmentioning

confidence: 99%

Weight Loss Decreases Excess Pancreatic Triacylglycerol Specifically in Type 2 Diabetes

et al. 2015

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“…Patient population and study design have previously been described (12). Briefly, a total of 23 morbidly obese patients (BMI $40 kg/m 2 or $36 kg/m 2 with an additional obesity-related comorbid condition) were recruited from the SLEEVEPASS study, a larger randomized controlled clinical trial comparing different surgical techniques for the treatment of morbid obesity (ClinicalTrials.gov, NCT00793143).…”

Section: Patientsmentioning

confidence: 99%

Effect of Bariatric Surgery on Adipose Tissue Glucose Metabolism in Different Depots in Patients With or Without Type 2 Diabetes

et al. 2015

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OBJECTIVEWe investigated fat distribution and tissue-specific insulin-stimulated glucose uptake (GU) in seven fat compartments (visceral and subcutaneous) and skeletal muscle in morbidly obese patients with (T2D) and without (ND) type 2 diabetes before and 6 months after bariatric surgery. RESEARCH DESIGN AND METHODSA total of 23 obese patients (BMI 43.0 6 3.6 kg/m 2 ; 9 T2D and 14 ND) were recruited from a larger, randomized multicenter SLEEVEPASS study. MRI (for fat distribution) and [18 F]-fluorodeoxyglucose PET (for GU) studies were performed for the obese patients before and 6 months postsurgery; 10 lean subjects served as control subjects and were studied once. RESULTSAt baseline, visceral fat GU was 30 6 7% of muscle GU in control subjects and 57 6 5% in obese patients. Visceral and deep subcutaneous fat were more abundant (despite same total fat mass) and less insulin sensitive in T2D than ND; in both, GU was impaired compared with control subjects. Postsurgery, visceral fat mass decreased (∼40%) more than subcutaneous fat (7%). Tissue-specific GU was improved, but not normalized, at all sites in T2D and ND alike. The contribution of visceral fat to whole-body GU was greater in T2D than ND but decreased similarly with surgery. Subcutaneous fat made a fourfold greater contribution to whole-body GU in obese versus lean subjects (15% vs. 4%) both before and after surgery. CONCLUSIONSBariatric surgery leads to sustained weight loss and improves tissue-specific glucose metabolism in morbidly obese patients. We conclude that 1) enhanced visceral fat accumulation is a feature of T2D, 2) severe obesity compromises muscle insulin sensitivity more than fat insulin sensitivity, and 3) fat mass expansion is a sink for plasma glucose.Visceral fat (VF) and subcutaneous fat (SC) are structurally, metabolically, and functionally distinct, albeit both contribute to obesity (1). Abdominal SC fat has clearly defined, metabolically distinct deep and superficial layers separated by the Scarpa fascia (2,3). Research suggests that the deep layers are metabolically more active

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“…Other study done which also suggest weight loss & BMI reduction are as follows. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] In all diabetes pt, post-operative reduction in HbA1c (<6 normal value).In 40% patients were <6 & 35% patients were near normal range (6.1-6.5). There is good glycemic control after bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of LSG versus LRYGBP bariatric surgery in management of morbid obesity and type 2 diabetes mellitus in terms of percentage weight loss and T2DM resolution

et al. 2015

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Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patients

Cited by 90 publications

References 27 publications

Weight Loss Decreases Excess Pancreatic Triacylglycerol Specifically in Type 2 Diabetes

Weight Loss Decreases Excess Pancreatic Triacylglycerol Specifically in Type 2 Diabetes

Effect of Bariatric Surgery on Adipose Tissue Glucose Metabolism in Different Depots in Patients With or Without Type 2 Diabetes

Comparative analysis of LSG versus LRYGBP bariatric surgery in management of morbid obesity and type 2 diabetes mellitus in terms of percentage weight loss and T2DM resolution

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