Restoration of Acute Insulin Response in T2DM Subjects 1 Month After Biliopancreatic Diversion

Briatore, L.; Salani, Barbara; Andraghetti, Gabriella; Danovaro, C.; Sferrazzo, Elsa; Scopinaro, Nicola; Adami, Gian Franco; Maggi, Davide; Cordera, Renzo

doi:10.1038/oby.2007.9

Cited by 60 publications

(52 citation statements)

References 41 publications

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“…Parallel decreases were observed over the first 6 mo in normo-and hyperglycemic subjects, and steady states were achieved by 24 mo. Early and long-term decreases in HOMA-IR following various bariatric surgeries have been frequently reported (4,8,34,36). Although fat mass decreased by Ϫ13% from baseline to 1 mo following surgery, crosssectional and longitudinal associations between fat mass and HOMA-IR over that time period were not observed, suggesting that mechanisms responsible for improvement in hepatic Si may be related to caloric restriction rather than decreasing adiposity (17).…”

Section: Discussionmentioning

confidence: 92%

“…In light of the importance of ␤-cell function as a determinant of glucose tolerance, various studies have estimated changes in this parameter following biliopancreatic diversion (8,19,21,37,41) and RYGB surgery (19,25,27,46) as well as lifestyle intervention (13,43) and pharmacotherapy (10,45). However, only a few longitudinal studies of bariatric surgery (19,21,41) have simultaneously measured both insulin secretion and peripheral Si and thus derived the DI, an estimate that adjusts insulin secretory response to the prevailing level of insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

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Improvement in β-cell function in patients with normal and hyperglycemia following Roux-en-Y gastric bypass surgery

Lee¹,

Liang²,

Frediani

et al. 2010

American Journal of Physiology-Endocrinology and Metabolism

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-Glycemic disorders resolve following Roux-en-Y gastric bypass (RYGB) surgery, but early and longer-term mechanisms regarding effects on ␤-cell dysfunction as well as relationships with decreasing adiposity are not well understood. We evaluated longitudinal changes in peripheral insulin sensitivity (Si), the acute insulin response to glucose (AIRg), and the composite estimate of ␤-cell function, the disposition index (DI), over 24 mo via frequently sampled intravenous glucose tolerance testing in severely obese women who had fasting normoglycemia (n ϭ 16) and hyperglycemia (n ϭ 11) before RYGB surgery; homeostatic model assessment (HOMA-IR) estimated insulin resistance; air displacement plethysmography determined adipose tissue mass. At baseline, subjects with normoglycemia had adequate DI associated with elevated AIRg, but DI was markedly reduced in subjects with hyperglycemia. Within 1-6 mo post-RYGB, glycemic control was normalized in subjects with hyperglycemia related to reduced HOMA-IR (Ϫ54% at 1 mo, P Ͻ 0.005) and increased DI (23-fold at 6 mo vs. baseline, P Ͻ 0.05). Over 24 mo, DI improved in subjects with hyperglycemia (15-fold vs. baseline, P Ͻ 0.005) and also modestly in subjects with normoglycemia (58%, P Ͻ 0.05), due largely to increased Si. Decreasing adiposity correlated with longer-term HOMA-IR and Si values at 6 and 24 mo, respectively. In patients exhibiting fasting hyperglycemia before surgery, ␤-cell function improved early following RYGB, due largely to increases in insulin secretion. For both normoglycemic and hyperglycemic subjects, further improvement or stabilization of ␤-cell function over the 2 yr is due largely to improved Si associated with reduced adiposity. disposition index; weight loss; adipose tissue mass SEVERE OBESITY, DEFINED AS body mass index greater than 40 kg/m 2 , is associated with an increased prevalence of type 2 diabetes (T2DM) (5). Bariatric surgery is the most efficient method of producing substantial weight loss in severely obese patients (42). Surgical procedures induce weight loss by reducing the volume of the stomach, thereby restricting food intake, or by diverting the flow of ingested food to the ileum and bypassing the duodenum and the proximal jejunum, which promotes malabsoption (39). Roux-en-Y gastric bypass (RYGB) is a common and restrictive plus malabsorptive procedure; other procedures include adjustable gastric banding, a restrictive-only surgery, and biliopancreatic diversion, a primarily malabsorptive procedure that is less common in the US. (39).As has been found in overweight and obese individuals (47), severely obese persons with prediabetes and diabetes have a decline in ␤-cell function such that insulin secretion is inadequate to compensate for reduced insulin sensitivity (Si) (19,37). A special feature of bariatric surgery is its ability to induce remission of T2DM (9). Following adjustable gastric banding, remission of diabetes is strongly related to weight loss (15, 38). However, a greater effect of diabetes resolution is seen with malabsor...

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Improvement in β-cell function in patients with normal and hyperglycemia following Roux-en-Y gastric bypass surgery

Lee¹,

Liang²,

Frediani

et al. 2010

American Journal of Physiology-Endocrinology and Metabolism

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“…Briatore et al [20] demonstrated that BPD reduced insulin resistance in morbidly obese diabetic subjects and restored the acute insulin response a few weeks after surgery when all subjects had minimal body weight loss. Even more recently, Salinari et al [9] found that in obese diabetic patients, the first phase of insulin secretion after the IVGTT and b-cell glucose sensitivity were fully normalized 1 month after BPD when a significant body weight loss was observed.…”

Section: Discussionmentioning

confidence: 98%

First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis

et al. 2011

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Restoration of the first phase of insulin secretion and improved insulin sensitivity in diabetic obese patients immediately after SG, before any food passage through the gastrointestinal tract and before any weight loss, seem to be related to ghrelin, GLP-1, and PYY hormonal changes of possible gastric origin and was neither meal- nor weight-change-related. Duration of the disease up to 10.5 years seems to be a major cut off in the pathophysiological changes induced by SG. A "gastric" hypothesis may be put forward to explain the antidiabetes effect of SG.

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“…With purely or mostly restrictive procedures, ␤-cell function shows progressive improvement over time, paralleling ongoing weight loss. With BPD, almost complete recovery of AIR has been reported in a small group of type 2 diabetic patients as early as 1 month postsurgery (59).…”

Section: Bariatric Surgery and ␤-Cell Functionmentioning

confidence: 99%

Impact of Different Bariatric Surgical Procedures on Insulin Action and β-Cell Function in Type 2 Diabetes

2009

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Restoration of Acute Insulin Response in T2DM Subjects 1 Month After Biliopancreatic Diversion

Cited by 60 publications

References 41 publications

Improvement in β-cell function in patients with normal and hyperglycemia following Roux-en-Y gastric bypass surgery

Improvement in β-cell function in patients with normal and hyperglycemia following Roux-en-Y gastric bypass surgery

First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis

Impact of Different Bariatric Surgical Procedures on Insulin Action and β-Cell Function in Type 2 Diabetes

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