Insulin Sensitivity and Secretion in Obese Type 2 Diabetic Women after Various Bariatric Operations

Abstract

Objective: To compare the effects of biliopancreatic diversion (BPD) and laparoscopic gastric banding (LAGB) on insulin sensitivity and secretion with the effects of laparoscopic gastric plication (P). Methods: A total of 52 obese women (age 30-66 years) suffering from type 2 diabetes mellitus (T2DM) were prospectively recruited into three study groups: 16 BPD; 16 LAGB, and 20 P. Euglycemic clamps and mixed meal tolerance tests were performed before, at 1 month and at 6 months after bariatric surgery. Beta cell function derived from the meal test parameters was evaluated using mathematical modeling. Results: Glucose disposal per kilogram of fat free mass (a marker of peripheral insulin sensitivity) increased significantly in all groups, especially after 1 month. Basal insulin secretion decreased significantly after all three types of operations, with the most marked decrease after BPD compared with P and LAGB. Total insulin secretion decreased significantly only following the BPD. Beta cell glucose sensitivity did not change significantly post-surgery in any of the study groups. Conclusion: We documented similar improvement in insulin sensitivity in obese T2DM women after all three study operations during the 6-month postoperative follow-up. Notably, only BPD led to decreased demand on beta cells (decreased integrated insulin secretion), but without increasing the beta cell glucose sensitivity.

The relation between postprandial glucagon-like peptide-1 release and insulin sensitivity before and after bariatric surgery in humans with class II/III obesity

“…The negative association between GLP-1 and insulin release following the meal indicates that the relationship between GLP-1 release and hepatic or whole-body insulin sensitivity is stronger than its incretin effect. The relative abundance of postprandial insulin in our data compared with the results from other studies [39,40] is likely an effect of the larger meal size used in this study (964 versus 300-500 kcal in previous studies).…”

The effect of surgical gastric plication on obesity and diabetes mellitus type 2: a systematic review and meta-analysis.

“…Two small studies [ 24 , 30 ], focusing on the effect on diabetes mellitus type 2 after LGCP, estimated an improvement in 6-month follow-up not only in DM type 2 but also in the metabolic profile of the patients. In both studies, GIP levels increased after the plication, with Vrbikova et al .…”

“…In both studies, GIP levels increased after the plication, with Vrbikova et al . [ 30 ] reporting a decrease of C peptide as a marker of DM T2 after LGCP and Bradnova [ 24 ] finding a statistically significant decrease in HbA 1c ( p < 0.0001) and improvement of hyperglycemia ( p < 0.05). DM T2 was resolved in 4/20 (20%) patients and improved in 12/20 (60%) at 6-month follow-up.…”

“…Most studies only had a short-term follow-up period of 1–18 months [ 16 – 18 , 20 , 24 , 25 , 27 , 29 , 30 ], which revealed an effective decrease in weight and improvement or remission in diabetes mellitus over that time. Only 5 studies published longer follow-up data, 4 of which reported an average follow-up to 5 years, and only one study had a follow-up of 10 years.…”

“…The remission of diabetes in most studies was based on the HbA 1c value decreasing postoperatively (> 0.5 decrease), which shows a mean decrease in HbA 1c of 1.625 over the 6 studies [ 16 , 17 , 19 , 20 , 27 , 30 ]. Other studies determined DM T2 remission by either withdrawal of medication and/or insulin.…”