Document Detail


Improvement in Insulin Sensitivity and Β-Cell Function Following Ileal Interposition with Sleeve Gastrectomy in Type 2 Diabetic Patients: Potential Mechanisms.
MedLine Citation:
PMID:  21557013     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Aureo Ludovico De Paula; Alessandro R Stival; Alfredo Halpern; Carolina C L Depaula; Andrea Mari; Elza Muscelli; Sergio Vencio; Ele Ferrannini
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-10
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  -     ISSN:  1873-4626     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Surgery, Hospital de Especialidades, Av. 136, no. 961, 14 andar, Setor Marista, 74.093-250, Goiânia, Goiás, Brazil, adepaula@uol.com.br.
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