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Surgical Treatment of Type 2 Diabetes in Subjects with Mild Obesity: Mechanisms Underlying Metabolic Improvements

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Abstract

Background

This study aims to assess the clinical and physiological effects of Roux-en-Y gastric bypass (RYGBP) on type 2 diabetes associated with mild obesity (body mass index [BMI] 30–34.9 kg/m2) over 24 months postsurgery.

Methods

In this prospective trial, 36 mildly obese subjects (19 males) with type 2 diabetes using oral antidiabetic drugs with (n = 24) or without insulin (n = 12) underwent RYGBP. Follow-up was conducted at baseline and 3, 6, 12, and 24 months postsurgery. The following endpoints were considered: changes in HbA1c, fasting glucose and insulin, antidiabetic therapy, BMI, oral glucose insulin sensitivity [OGIS, from meal tolerance test (MTT)], beta-cell secretory function [ΔCP(0–30)/ΔGlu(0–30) (ΔC-peptide/Δglucose ratio, MTT 0–30 min), disposition index (DI = OGIS ⋅ ΔCP(0–30)/ΔGlu(0–30)], glucagon-like peptide (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) [incremental area under the curve (AUCi)], adiponectin, C-reactive protein, and lipids.

Results

All subjects achieved normal-to-overweight BMI after 3 months. Over 24 months, 31/36 (86 %) subjects presented HbA1c <7 % [complete and partial remission of diabetes in 9/36 (22 %) and 1/36 (3 %), respectively]. Since 3 months postsurgery, improvements were observed in OGIS [290 (174) to 373 (77) ml/min/m2, P = 0.009], ΔCP(0–30)/ΔGlu(0–30) [0.24 (0.19) to 0.52 (0.34) ng/mg, P = 0.001], DI [7.16 (8.53) to 19.8 (15.4) (ng/mg) (ml/min/m2), P = 0.001], GLP-1 AUCi [0.56 (0.64) to 3.97 (3.86) ng/dl ⋅ 10 min ⋅ 103, P = 0.000], and GIP AUCi [30.2 (12.6) to 27.0 (20.2) ng/dl ⋅ 10 min ⋅ 103, P = 0.004]. At baseline and after 12 months, subjects with diabetes nonremission had longer diabetes duration, higher HbA1c, lower beta-cell secretory function, and higher first 30-min GIP AUCi, compared with those with remission.

Conclusions

RYGBP improves the glucose metabolism in subjects with type 2 diabetes and mild obesity. This effect is associated with improvement of insulin sensitivity, beta-cell secretory function, and incretin secretion.

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Acknowledgments

This work was supported by Ethicon Endo-Surgery.

Conflict of Interest

The authors disclose no conflict of interest.

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Authors and Affiliations

  1. Laboratory of Investigation in Metabolism and Diabetes (LIMED)/Gastrocentro, State University of Campinas (UNICAMP), R. Carlos Chagas, 420, Cidade Universitária, Campinas, SP, 13081-970, Brazil

    A. C. Fellici, G. Lambert, M. M. O. Lima, J. C. Pareja, S. Rodovalho & Bruno Geloneze

  2. National Institute of Science and Technology of Obesity and Metabolism, National Council for Scientific and Technological Development (CNPq), Campinas, Brazil

    J. C. Pareja & Bruno Geloneze

  3. Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil

    J. C. Pareja & E. A. Chaim

Authors
  1. A. C. Fellici
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  2. G. Lambert
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  3. M. M. O. Lima
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  4. J. C. Pareja
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  5. S. Rodovalho
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  6. E. A. Chaim
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  7. Bruno Geloneze
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Corresponding author

Correspondence to Bruno Geloneze.

Additional information

Ana Cláudia Fellici and Giselle Lambert contributed equally to this work.

This study is registered at clinicaltrials.gov (NCT00566189).

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Fellici, A.C., Lambert, G., Lima, M.M.O. et al. Surgical Treatment of Type 2 Diabetes in Subjects with Mild Obesity: Mechanisms Underlying Metabolic Improvements. OBES SURG 25, 36–44 (2015). https://doi.org/10.1007/s11695-014-1377-9

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  • DOI: https://doi.org/10.1007/s11695-014-1377-9

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