Article

Restoration of acute insulin response in T2DM subjects 1 month after biliopancreatic diversion

Department of Endocrinology and Medicine, University of Genova, Genova, Italy.
Obesity (Impact Factor: 4.39). 01/2008; 16(1):77-81. DOI: 10.1038/oby.2007.9
Source: PubMed

ABSTRACT Biliopancreatic diversion (BPD) restores normal glucose tolerance in a few weeks in morbid obese subjects with type 2 diabetes, improving insulin sensitivity. However, there is less known about the effects of BPD on insulin secretion. We tested the early effects of BPD on insulin secretion in obese subjects with and without type 2 diabetes.
Twenty-one consecutive morbid obese subjects, 9 with type 2 diabetes (T2DM) and 12 with normal fasting glucose (NFG) were evaluated, just before and 1 month after BPD, by measuring body weight (BW), glucose, adipocitokines, homeostasis model assessment of insulin resistance (HOMA-IR), acute insulin response (AIR) to e.v. glucose and the insulinogenic index adjusted for insulin resistance ([DeltaI5/DeltaG5]/HOMA-IR).
Preoperatively, those with T2DM differed from those with NFG in showing higher levels of fasting glucose, reduced AIR (57.9 +/- 29.5 vs. 644.9 +/- 143.1 pmol/l, P < 0.01) and reduced adjusted insulinogenic index (1.0 +/- 0.5 vs. 17.6 +/- 3.9 1/mmol(2), P < 0.001). One month following BPD, in both groups BW was reduced (by approximately 11%), but all subjects were still severely obese; HOMA-IR and leptin decreased significanlty, while high-molecular weight (HMW) adiponectin and adjusted insulinogenic index increased. In the T2DM group, fasting glucose returned to non-diabetic values. AIR did not change in the NFG group, while in the T2DM group it showed a significant increase (from 58.0 +/- 29.5 to 273.8 +/- 47.2 pmol/l, P < 0.01). In the T2DM group, the AIR percentage variation from baseline was significantly related to changes in fasting glucose (r = 0.70, P = 0.02), suggesting an important relationship exists between impaired AIR and hyperglycaemia.
BPD is able to restore AIR in T2DM even just 1 month after surgery. AIR restoration is associated with normalization of fasting glucose concentrations.

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    • "From [46], insulin concentration and peak insulin during OGTT increase while fasting insulin decreases around 25% after RYGB. From Briatore 2008, fasting insulin decreases around 50%, acute insulin response or early insulin secretion increase, after BPD [83]. From Valverde 2005 fasting insulin decreases 75%, insulin concentrations decrease but the incremental area in plasma insulin concentration over the first 30 min of the OGTT test was higher after BPD [84]. "
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    ABSTRACT: Consensus exists that several bariatric surgery procedures produce a rapid improvement of glucose homeostasis in obese diabetic patients, improvement apparently uncorrelated with the degree of eventual weight loss after surgery. Several hypotheses have been suggested to account for these results: among these, the anti-incretin, the ghrelin and the lower-intestinal dumping hypotheses have been discussed in the literature. Since no clear-cut experimental results are so far available to confirm or disprove any of these hypotheses, in the present work a mathematical model of the glucose-insulin-incretin system has been built, capable of expressing these three postulated mechanisms. The model has been populated with critically evaluated parameter values from the literature, and simulations under the three scenarios have been compared. The modeling results seem to indicate that the suppression of ghrelin release is unlikely to determine major changes in short-term glucose control. The possible existence of an anti-incretin hormone would be supported if an experimental increase of GIP concentrations were evident post-surgery. Given that, on the contrary, collected evidence suggests that GIP concentrations decrease post-surgery, the lower-intestinal dumping hypothesis would seem to describe the mechanism most likely to produce the observed normalization of Type 2 Diabetes Mellitus (T2DM) after bariatric surgery. The proposed model can help discriminate among competing hypotheses in a context where definitive data are not available and mechanisms are still not clear.
    Theoretical Biology and Medical Modelling 05/2012; 9(1):16. DOI:10.1186/1742-4682-9-16 · 1.27 Impact Factor
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    • "However, the normalization of insulin sensitivity after BPD is maintained after weight has stabilized around BMI 30 that is still in the obese range. Moreover, differently from other bariatric procedures, BPD has shown the ability to restore acute insulin response to intravenous glucose load (AIR) in morbidly obese patients, both at short (Briatore et al, 2008) and long term (Polyzogopoulou et al, 2003). "
    Advanced Bariatric and Metabolic Surgery, 02/2012; , ISBN: 978-953-307-926-4
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