TITLE

Improvement in insulin sensitivity and β-cell function following ileal interposition with sleeve gastrectomy in type 2 diabetic patients: potential mechanisms

AUTHOR(S)
Paula, Aureo; Stival, Alessandro; Halpern, Alfredo; DePaula, Carolina; Mari, Andrea; Muscelli, Elza; Vencio, Sergio; Ferrannini, Ele; De Paula, Aureo Ludovico; Stival, Alessandro R; DePaula, Carolina C L
PUB. DATE
August 2011
SOURCE
Journal of Gastrointestinal Surgery;Aug2011, Vol. 15 Issue 8, p1344
SOURCE TYPE
Academic Journal
DOC. TYPE
journal article
ABSTRACT
Introduction: Bariatric surgery in morbidly obese type 2 diabetic (T2DM) patients is associated with high rates of diabetes remission. We investigated the mechanisms of the anti-diabetic effect of the laparoscopic ileal interposition with sleeve gastrectomy (LII-SG) in normal weight (NW), overweight (OW) and obese (OB) T2DM patients.Methods: Ninety-four patients (aged 54 ± 8 years) with long-standing (median 10 years), treated diabetes (median HbA(1c) = 8.6%), who were NW (15), OW (64) or OB (15) based on BMI, underwent LII-SG. Insulin sensitivity and parameters of ß-cell function were measured from an Oral Glycaemic Tolerance Test pre- and post-operatively.Results: At a median of 13.4 months post-operatively, weight loss averaged 9.4 ± 1.3, 16.8 ± 0.8 and 23.2 ± 1.7 kg in NW, OW and OB subjects, respectively (p < 0.0001). Insulin sensitivity was fully restored (395 [108] vs 208 [99] ml min⁻¹ m⁻²), fasting insulin secretion rate decreased (68 [52] vs 146 [120] pmol min⁻¹ m⁻²) and total insulin output increased (52 [26] vs 39 [28] nmol m⁻², all p ≤ 0.001). ß-cell glucose sensitivity doubled (37 [33] vs 18 [24] mol min⁻¹ m⁻² mM⁻¹, p < 0.0001). The only parameter predicting remission of diabetes was a lower baseline insulin sensitivity (p = 0.005).Conclusions: LII-SG induced changes on T2DM by mechanisms in part distinct from weight loss, principally involving restoration of insulin sensitivity and improvement of ß-cell function.
ACCESSION #
63235054

 

Related Articles

  • Effect of fruit restriction on glycemic control in patients with type 2 diabetes - a randomized trial. Christensen, Allan S.; Viggers, Lone; Hasselström, Kjeld; Gregersen, Søren // Nutrition Journal;2013, Vol. 12, p1 

    Background: Medical nutrition therapy is recognized as an important treatment option in type 2 diabetes. Most guidelines recommend eating a diet with a high intake of fiber-rich food including fruit. This is based on the many positive effects of fruit on human health. However some health...

  • The Effect and Predictive Score of Gastric Bypass and Sleeve Gastrectomy on Type 2 Diabetes Mellitus Patients with BMI < 30 kg/m. Lee, Wei-Jei; Almulaifi, Abdullah; Chong, Keong; Chen, Shu-Chun; Tsou, Jun; Ser, Kong-Han; Lee, Yi-Chih; Chen, Jung-Chien // Obesity Surgery;Oct2015, Vol. 25 Issue 10, p1772 

    Background: Metabolic surgery is a novel therapy for mild obesity (BMI 30-35 Kg/m) in type 2 diabetes mellitus (T2DM) patients. The ABCD score, which comprise age, BMI, C-peptide level, and duration of T2DM (years), was reported as useful in predicting the success of T2DM treatment using...

  • Impact of Baseline BMI on Glycemic Control and Weight Change with Metformin Monotherapy in Chinese Type 2 Diabetes Patients: Phase IV Open-Label Trial. Ji, Linong; Li, Hongmei; Guo, Xiaohui; Li, Yan; Hu, Renming; Zhu, Zhengying // PLoS ONE;Feb2013, Vol. 8 Issue 2, p1 

    Background: Differences exist between treatment recommendations regarding the choice of metformin as first-line therapy for type 2 diabetes patients according to body mass index (BMI). This study compared the efficacy of metformin monotherapy among normal-weight, overweight, and obese patients...

  • Efficacy of Exenatide Therapy over 12 Months in a "Real World" Setting. Loh, Jennifer A.; Clement, Stephen C. // Diabetes;Jun2007 Supplement 1, Vol. 56, pA152 

    While Phase III trial data for exenatide has shown significant long-term efficacy in patients with type 2 diabetes, these studies were not analyzed by intention to treat and may not reflect "real world" clinical practice. In addition, many practitioners prescribe exenatide to type 2 diabetics on...

  • Metabolic Laparoscopic Gastric Bypass for Obese Patients with Type 2 Diabetes. Nora, Mário; Guimarães, Marta; Almeida, Rui; Martins, Paulo; Gonçalves, Gil; Freire, Maria; Ferreira, Tiago; Freitas, Cláudia; Monteiro, Mariana // Obesity Surgery;Nov2011, Vol. 21 Issue 11, p1643 

    Background: Bariatric surgery has been proposed as the most effective treatment for patients with type 2 diabetes mellitus (T2DM) and body mass index (BMI) above 35 kg/m. The purpose of our study was to access remission rate and improvement of metabolic control of T2DM after gastric bypass....

  • Diabetes improvement after bariatric surgery is dependent on weight loss. KAPLAN, LEE M.; SEELEY, RANDY J.; HARRIS, JASON L. // Bariatric Times;Apr2014, Vol. 11 Issue 4, pc14 

    The article discusses the role of bariatric surgery for the treatment of type 2 diabetes mellitus (T2DM). Topics discussed include the gastrointestinal weight loss surgical procedures for improvement of T2DM, mechanism of action of postoperative improvement in diabetes and the effects of...

  • GIP and Bariatric Surgery. Rao, Raghavendra S.; Kini, Subhash // Obesity Surgery;Feb2011, Vol. 21 Issue 2, p244 

    Bariatric surgery is the most effective modality of achieving weight loss as well as the most effective treatment for type 2 diabetes mellitus (T2DM). Glucose-dependent insulinotropic polypeptide (GIP) is an incretin and is implicated in the pathogenesis of obesity and T2DM. Its role in weight...

  • FXR is a molecular target for the effects of vertical sleeve gastrectomy. Ryan, Karen K.; Tremaroli, Valentina; Clemmensen, Christoffer; Kovatcheva-Datchary, Petia; Myronovych, Andriy; Karns, Rebekah; Wilson-Pérez, Hilary E.; Sandoval, Darleen A.; Kohli, Rohit; Bäckhed, Fredrik; Seeley, Randy J. // Nature;5/8/2014, Vol. 509 Issue 7499, p183 

    Bariatric surgical procedures, such as vertical sleeve gastrectomy (VSG), are at present the most effective therapy for the treatment of obesity, and are associated with considerable improvements in co-morbidities, including type-2 diabetes mellitus. The underlying molecular mechanisms...

  • Determining predictors of response to exenatide in type 2 diabetes. Anderson, Sarah L.; Trujillo, Jennifer M.; Mcdermott, Michael; Sasee, Joseph J. // Journal of the American Pharmacists Association: JAPhA;Jul/Aug2012, Vol. 52 Issue 4, p466 

    Objectives: To determine predictors of glycemic response to exenatide and to assess change in glycosylated hemoglobin (A1C) and whether a correlation exists between weight loss and giycemic response. Design: Retrospective observational cohort study. Setting: United States in 2009. Patients: 100...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics