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Long-Term Outcomes of Biliopancreatic Diversion on Glycemic Control, Insulin Sensitivity and Beta Cell Function

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Abstract

Background

We aimed to assess the long-term outcomes of biliopancreatic diversion (BPD) surgery on glycemic control, insulin sensitivity (IS), and beta cell function using complementary oral and intravenous dynamic tests.

Methods

A total of 57 women were divided into three groups: 19 lean, 18 obese (both groups with normal glucose tolerance (NGT)), and 20 obese with type 2 diabetes who underwent BPD and were reassessed 12 months after the procedure. OGTTs and hyperglycemic clamps (HG) were performed. Mathematical modeling was used to analyze IS, beta cell function, and delayed time of beta cell response. The basal, dynamic (first phase/steps of insulin secretion), and static (second phase/steps of insulin secretion) disposition indexes were calculated.

Results

After surgery, the patients exhibited improvements in glycemic control and 15 patients achieved diabetes remission. The surgical patients demonstrated normalized IS in OGGT and HG tests compared to the control groups. The basal beta cell function was improved but remained impaired compared to the Lean NGT group. The stimulated beta cell function parameters showed marked improvements regarding the intravenous stimulus and the second phase/distal steps of insulin secretion. The delay time markedly decreased and became normalized in both dynamic tests.

Conclusions

The common physiopathology features of type 2 diabetes, i.e., impaired IS and beta cell dysfunction, were demonstrated to be primarily functional and were likely to be reversible to some degree after the BPD. The marked long-term improvement in glycemic control after BPD was closely related to IS improvement and mainly by the recovery of several beta cell physiological features.

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Author notes

  1. Ana Carolina Junqueira Vasques

    Present address: Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas, Campinas, SP, Brazil

Authors and Affiliations

  1. Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas, Campinas, SP, Brazil

    José Carlos Pareja, Maria da Saúde de Oliveira, Fernanda Satake Novaes, Marcelo Miranda Oliveira Lima & Bruno Geloneze

  2. School of Applied Sciences, University of Campinas, Limeira, Brazil

    Ana Carolina Junqueira Vasques

  3. Department of Surgery, University of Campinas, Campinas, Brazil

    José Carlos Pareja & Élinton A. Chaim

  4. Department of Information Engineering, University of Padova, Padova, Italy

    Francesca Piccinini, Chiara Dalla Man & Claudio Cobelli

Authors
  1. Ana Carolina Junqueira Vasques
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  2. José Carlos Pareja
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  3. Maria da Saúde de Oliveira
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Corresponding author

Correspondence to Ana Carolina Junqueira Vasques.

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Funding

São Paulo Research Foundation - FAPESP, grants 2008/09451-7, 2008/07312-0, and 15/07900-2.

Conflict of Interest

The authors Ana Carolina J. Vasques, José C. Pareja, Maria da S. de Oliveira, Fernanda S. Novaes, Marcelo M. O. Lima, Élinton A. Chaim, Francesca Picinini, Chiara D. Man, Claudio Cobelli, and Bruno Geloneze declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Vasques, A.C.J., Pareja, J.C., da Saúde de Oliveira, M. et al. Long-Term Outcomes of Biliopancreatic Diversion on Glycemic Control, Insulin Sensitivity and Beta Cell Function. OBES SURG 26, 2572–2580 (2016). https://doi.org/10.1007/s11695-016-2159-3

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  • DOI: https://doi.org/10.1007/s11695-016-2159-3

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