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Obesity Surgery

, Volume 29, Issue 1, pp 239–245 | Cite as

Type 2 Diabetes Remission and Control in Overweight and in Mildly Obese Diabetic Patients at Long-Term Follow-Up After Biliopancreatic Diversion

  • Gian Franco AdamiEmail author
  • Giovanni Camerini
  • Francesco Papadia
  • Maria Francesca Catalano
  • Flavia Carlini
  • Renzo Cordera
  • Nicola Scopinaro
Original Contributions

Abstract

Background

In severely obese patients with type 2 diabetes (T2DM), the metabolic benefits after biliopancreatic diversion (BPD) are due to mechanisms independent of weight loss. Therefore, the anti-diabetic effect of BPD in overweight or mildly obese T2DM patients was investigated.

Methods

Ninety T2DM patients with BMI 25–35 underwent BPD and were evaluated 1 and 5 years after the operation (follow-up rate 100 and 83%, respectively).

Results

T2DM control (Hb1Ac < 7%) and remission (Hb1Ac < 6 without antidiabetics) was observed in 86.6 and 65% of cases at 1 year and 64.0% and 26.5% at 5 years, respectively. The long-term T2DM remission was predicted by baseline BMI value. Both before BPD and throughout the follow-up period, HOMA values were similar in the metabolically successful and unsuccessful subjects, while C-peptide normalized for FBG value as a marker of beta cell mass and insulin secretion increased progressively only in the former from 1.06 ± 0.64 to 1.44 ± 1.08 mcg/l ml/dl−1 * 100 (p < 0.002).

Conclusions

In T2DM patients with BMI of 25–35, a positive metabolic outcome is less frequent than in their counterparts with morbid obesity. In T2DM overweight patients, in spite of a short-term normalization of FBG and HbA1c levels and a well-sustained increase of insulin sensitivity, a long-term T2DM relapse occurs in the majority of the cases. While the surgically obtained decrease in insulin resistance leads to T2DM control in half of the patients, the increase in insulin secretion is mandatory for T2DM stable remission.

Keywords

Bariatric surgery Type 2 diabetes Non-morbidly obese patients Diabetes control Diabetes remission Insulin secretion 

Notes

Compliance with Ethical Standards

The studies were approved by the local ethical committee, and all patients gave their informed consent.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Scopinaro N, Marinari GM, Camerini GB, et al. Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: a long-term follow-up study. Diabetes Care. 2005;28:2406–11.CrossRefGoogle Scholar
  2. 2.
    Jacobsen SH, Olesen SC, Dirksen C, et al. Changes in gastrointestinal hormone responses, insulin sensitivity, and beta-cell function within 2 weeks after gastric bypass in non-diabetic subjects. Obes Surg. 2012;22:1084–96.CrossRefGoogle Scholar
  3. 3.
    Holst JJ. Enteroendocrine secretion of gut hormones in diabetes, obesity and after bariatric surgery. Curr Opin Pharmacol. 2013;13:983–8.CrossRefGoogle Scholar
  4. 4.
    Mingrone G, Nolfe G, Gissey GC, et al. Circadian rhythms of GIP and GLP1 in glucose-tolerant and in type 2 diabetic patients after biliopancreatic diversion. Diabetologia. 2009;52:873–81.CrossRefGoogle Scholar
  5. 5.
    Astiarraga B, Gastaldelli A, Muscelli E, et al. Biliopancreatic diversion in nonobese patients with type 2 diabetes: impact and mechanisms. J Clin Endocrinol Metab. 2013;98:2765–73.CrossRefGoogle Scholar
  6. 6.
    Guidone C, Manco M, Valera-Mora E, et al. Mechanisms of recovery from type 2 diabetes after malabsorptive bariatric surgery. Diabetes. 2006;55:2025–31.CrossRefGoogle Scholar
  7. 7.
    Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998;22:936–46.CrossRefGoogle Scholar
  8. 8.
    Falkén Y, Hellström PM, Holst JJ, et al. Changes in glucose homeostasis after Roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery: role of gut peptides. J Clin Endocrinol Metab. 2011;96:2227–35.CrossRefGoogle Scholar
  9. 9.
    Hinlst JJ. Enteroendocrine secretion of gut hormones in diabetes, obesity and after bariatric surgery. Curr Opin Pharmacol. 2013;13:983–8.CrossRefGoogle Scholar
  10. 10.
    Polyzogopoulou EV, Kalfarentzos F, Vagenakis AG, et al. Restoration of euglycemia and normal acute insulin response to glucose in obese subjects with type 2 diabetes following bariatric surgery. Diabetes. 2003;52:1098–103.CrossRefGoogle Scholar
  11. 11.
    Briatore L, Salani B, Andraghetti G, et al. Beta-cell function improvement after biliopancreatic diversion in subjects with type 2 diabetes and morbid obesity. Obesity (Silver Spring). 2010;18:932–6.CrossRefGoogle Scholar
  12. 12.
    Briatore L, Salani B, Andraghetti G, et al. Restoration of acute insulin response n T2DM subjects 1 month after biliopancreatic diversion. Obesity (Silver Spring). 2008;16:77–81.CrossRefGoogle Scholar
  13. 13.
    Scopinaro N, Camerini G, Papadia F, et al. Long term clinical and functional impact of biliopancreatic diversion on type 2 diabetes in morbidly and non–morbidly obese patients undergoing biliopancreatic diversion. Surg Obes Relat Dis. 2016;12:345–9.CrossRefGoogle Scholar
  14. 14.
    Scopinaro N, Adami GF, Papadia FS, et al. The effects of biliopancreatic diversion on type 2 diabetes mellitus in patients with mild obesity (BMI 30-35 kg/m2) and simple overweight (BMI 25-30 kg/m2): a prospective controlled study. Obes Surg. 2011;21:880–8.CrossRefGoogle Scholar
  15. 15.
    Scopinaro N, Adami GF, Papadia FS, et al. Effects of biliopanceratic diversion on type 2 diabetes in patients with BMI 25 to 35. Ann Surg. 2011;253:699–703.CrossRefGoogle Scholar
  16. 16.
    Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.CrossRefGoogle Scholar
  17. 17.
    Meier JJ, Menge BA, Breuer TG, et al. Functional assessment of pancreatic beta-cell area in humans. Diabetes. 2009;58:1595–603.CrossRefGoogle Scholar
  18. 18.
    Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32:2133–5.CrossRefGoogle Scholar
  19. 19.
    Schauer PR, Bhatt DL, Kirwan JP, et al. STAMPEDE investigators. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376:641–51.CrossRefGoogle Scholar
  20. 20.
    Panunzi S, Carlsson L, De Gaetano A, et al. Determinants of diabetes remission and glycemic control after bariatric surgery. Diabetes Care. 2016;39:166–74.CrossRefGoogle Scholar
  21. 21.
    Camerini GB, Papadia FS, Carlini F, et al. The long-term impact of biliopancreatic diversion on glycemic control in the severely obese with type 2 diabetes mellitus in relation to preoperative duration of diabetes. Surg Obes Relat Dis. 2016;12:345–9.CrossRefGoogle Scholar
  22. 22.
    Scopinaro N, Adami GF, Bruzzi P, et al. Prediction of diabetes remission at long term following biliopabcreatic diversion. Obes Surg. 2017;27:1705–8.CrossRefGoogle Scholar
  23. 23.
    Müller-Stich BP, Senft JD, Warschkow R, et al. Surgical versus medical treatment of type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis. Ann Surg. 2015;261:421–9.CrossRefGoogle Scholar
  24. 24.
    Horwitz D, Saunders JK, Ude-Welcome A, et al. Three-year follow-up comparing metabolic surgery versus medical weight management in patients with type 2 diabetes and BMI 30–35.Google Scholar
  25. 25.
    Cummings DE, Cohen RV. Bariatric/metabolic surgery to treat type 2 diabetes in patients with a BMI <35 kg/m2. Diabetes Care. 2016;39:924–33.CrossRefGoogle Scholar
  26. 26.
    Di J, Zhang H, Yu H, et al. Effect of Roux-en-Y gastric bypass on the remission of type 2 diabetes: a 3-year study in Chinese patients with a BMI <30 kg/m(2). Surg Obes Relat Dis. 2016;12:1357–63.CrossRefGoogle Scholar
  27. 27.
    Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–256.e5.CrossRefGoogle Scholar
  28. 28.
    Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311:2297–304.CrossRefGoogle Scholar
  29. 29.
    Schauer PR, Bhatt DL, Kirwan JP, et al. STAMPEDE Investigators. .Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370:2002–13.CrossRefGoogle Scholar
  30. 30.
    Faradji RN, Monroy K, Messinger S, et al. Simple measures to monitor beta-cell mass and assess islet graft dysfunction. Am J Transplant. 2007;7:303–8.CrossRefGoogle Scholar
  31. 31.
    Ritzel RA, Butler AE, Rizza RA, et al. Relationship between beta-cell mass and fasting blood glucose concentration in humans. Diabetes Care. 2006;29:717–8.CrossRefGoogle Scholar
  32. 32.
    Saisho Y, Butler AE, Manesso E, et al. β-cell mass and turnover in humans: effects of obesity and aging. Diabetes Care. 2013;36:111–7.CrossRefGoogle Scholar
  33. 33.
    Halban PA, Polonsky KS, Bowden DW, et al. β-cell failure in type 2 diabetes: postulated mechanisms and prospects for prevention and treatment. Diabetes Care. 2014;37:1751–8.CrossRefGoogle Scholar
  34. 34.
    Janikiewicz J, Hanzelka K, Kozinski K, et al. Islet β-cell failure in type 2 diabetes—within the network of toxic lipids. Biochem Biophys Res Commun. 2015;8(460):491–6.CrossRefGoogle Scholar
  35. 35.
    Weir GC, Bonner-Weir S. Islet β cell mass in diabetes and how it relates to function, birth, and death. Ann N Y Acad Sci. 2013;1281:92–105.CrossRefGoogle Scholar
  36. 36.
    Paniagua JA. Nutrition, insulin resistance and dysfunctional adipose tissue determine the different components of metabolic syndrome. World J Diabetes. 2016;7:483–514.CrossRefGoogle Scholar
  37. 37.
    Shulman GI. Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease. N Engl J Med. 2014;371:2237–8.CrossRefGoogle Scholar
  38. 38.
    Matveyenko AV, Butler PC. Relationship between beta-cell mass and diabetes onset. Diabetes Obes Metab. 2008;10(Suppl 4):23–31.CrossRefGoogle Scholar
  39. 39.
    Porte Jr D, Kahn SE. Beta-cell dysfunction and failure in type 2 diabetes: potential mechanisms. Diabetes. 2001;50(Suppl 1):S160–3.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal MedicineUniversity of GenovaGenoaItaly
  2. 2.Department of Internal Medicine and SurgeryUniversity of GenovaGenoaItaly

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