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

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

Proinsulin Insulin Obesity Bileopancreatic 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

Personalised recommendations