Obesity Surgery

, Volume 20, Issue 5, pp 549–558

Bileopancreatic Diversion with Duodenal Switch Lowers Both Early and Late Phases of Glucose, Insulin and Proinsulin Responses After Meal

  • Hans-Erik Johansson
  • Arvo Haenni
  • F. Anders Karlsson
  • Britt Edén-Engström
  • Margareta Öhrvall
  • Magnus Sundbom
  • Björn Zethelius
Clinical Research

DOI: 10.1007/s11695-010-0102-6

Cite this article as:
Johansson, H., Haenni, A., Karlsson, F.A. et al. OBES SURG (2010) 20: 549. doi:10.1007/s11695-010-0102-6

Abstract

Background

Hyperproinsulinemia is associated with obesity and type 2 diabetes. We explored the after-meal dynamics of proinsulin and insulin and postprandial effects on glucose and lipids in patients treated with bileopancreatic diversion with duodenal switch (BPD-DS) surgery compared with normal-weight controls [body mass index (BMI)±SD, 23.2 ± 2.4 kg/m2].

Methods

Ten previously morbidly obese (BMI±SD, 53.5 ± 3.8 kg/m2) patients free from diabetes who had undergone BPD-DS (BMI±SD, 29.0 ± 5.2 kg/m2) 2 years earlier were recruited. A standardised meal (2400 kJ) was ingested, and glucose, proinsulin, insulin, free fatty acids and triglycerides (TGs) were determined during 180 min. Follow-up characteristics yearly on glucose, lipids, creatinine and uric acid over 3 years after BPD-DS are presented.

Results

Fasting glucose and insulin were lower, 0.4 mmol/L and 4.6 pmol/L, respectively, in the BPD-DS group despite higher BMI. Fasting proinsulin was similar in both groups. Postprandial area under the curve (AUC) for glucose, proinsulin and insulin did not differ between the two groups (p = 0.106–734). Postprandial changes in glucose, proinsulin and insulin were essentially similar but absolute concentrations of proinsulin and insulin were lower in the later phases in the BPD-DS group (p = 0.052–0.001). Postprandial AUC for TGs was lower in the BPD-DS group (p = 0.005). Postprandial changes in TGs were lowered in the intermediate phase (p = 0.07–0.08) and in the late phase (0.002). Follow-up data showed markedly lowered creatinine and uric acid after BPD-DS.

Conclusions

BPD-DS surgery induces a large weight loss and lowers, close to normal, postprandial responses of glucose, proinsulin and insulin but with marked lowering of TGs.

Keywords

ProinsulinInsulinObesityBileopancreatic diversion with duodenal switch

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Hans-Erik Johansson
    • 1
  • Arvo Haenni
    • 1
  • F. Anders Karlsson
    • 2
  • Britt Edén-Engström
    • 2
  • Margareta Öhrvall
    • 1
  • Magnus Sundbom
    • 3
  • Björn Zethelius
    • 1
  1. 1.Department of Public Health and Caring Sciences/GeriatricsUppsala University HospitalUppsalaSweden
  2. 2.Department of Medical SciencesUppsala University HospitalUppsalaSweden
  3. 3.Department of Surgical SciencesUppsala University HospitalUppsalaSweden