Mechanisms of recovery from type 2 diabetes after malabsorptive bariatric surgery

Geltrude Mingrone, Caterina Guidone, Amerigo Iaconelli, Giuseppe Nanni, Marco Castagneto, M Manco, E Valera Mora, D Gniuli, A Mari, M Calvani

Risultato della ricerca: Contributo in rivistaArticolo in rivista

277 Citazioni (Scopus)

Abstract

Currently, there are no data in the literature regarding the pathophysiological mechanisms involved in the rapid resolution of type 2 diabetes after bariatric surgery, which was reported as an additional benefit of the surgical treatment for morbid obesity. With this question in mind, insulin sensitivity, using euglycemic-hyperinsulinemic clamp, and insulin secretion, by the C-peptide deconvolution method after an oral glucose load, together with the circulating levels of intestinal incretins and adipocytokines, have been studied in 10 diabetic morbidly obese subjects before and shortly after biliopancreatic diversion (BPD) to avoid the weight loss interference. Diabetes disappeared 1 week after BPD, while insulin sensitivity (32.96 +/- 4.3 to 65.73 +/- 3.22 mumol . kg fat-free mass(-1) . min(-1) at 1 week and to 64.73 +/- 3.42 mumol . kg fat-free mass(-1) . min(-1) at 4 weeks; P < 0.0001) was fully normalized. Fasting insulin secretion rate (148.16 +/- 20.07 to 70.0.2 +/- 8.14 and 83.24 +/- 8.28 pmol/min per m(2); P < 0.01) and total insulin output (43.76 +/- 4.07 to 25.48 +/- 1.69 and 30.50 +/- 4.71 nmol/m(2); P < 0.05) dramatically decreased, while a significant improvement in beta-cell glucose sensitivity was observed. Both fasting and glucose-stimulated gastrointestinal polypeptide (13.40 +/- 1.99 to 6.58 +/- 1.72 pmol/l at 1 week and 5.83 +/- 0.80 pmol/l at 4 weeks) significantly (P < 0.001) decreased, while glucagon-like peptide 1 significantly increased (1.75 +/- 0.16 to 3.42 +/- 0.41 pmol/l at 1 week and 3.62 +/- 0.21 pmol/l at 4 weeks; P < 0.001). BPD determines a prompt reversibility of type 2 diabetes by normalizing peripheral insulin sensitivity and enhancing beta-cell sensitivity to glucose, these changes occurring very early after the operation. This operation may affect the enteroinsular axis function by diverting nutrients away from the proximal gastrointestinal tract and by delivering incompletely digested nutrients to the ileum.
Lingua originaleEnglish
pagine (da-a)2025-2031
Numero di pagine7
RivistaDiabetes
Volume55
DOI
Stato di pubblicazionePubblicato - 2006

Keywords

  • Adiponectin
  • Area Under Curve
  • Bariatric Surgery
  • Blood Glucose
  • C-Peptide
  • Diabetes Mellitus, Type 2
  • Glucose Clamp Technique
  • Humans
  • Insulin
  • Middle Aged
  • Obesity, Morbid
  • Postoperative Period
  • Weight Loss

Fingerprint

Entra nei temi di ricerca di 'Mechanisms of recovery from type 2 diabetes after malabsorptive bariatric surgery'. Insieme formano una fingerprint unica.

Cita questo