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Improvement in Insulin Sensitivity and Β-Cell Function Following Ileal Interposition with Sleeve Gastrectomy in Type 2 Diabetic Patients: Potential Mechanisms

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Bariatric surgery in morbidly obese type 2 diabetic (T2DM) patients is associated with high rates of diabetes remission. We investigated the mechanisms of the anti-diabetic effect of the laparoscopic ileal interposition with sleeve gastrectomy (LII-SG) in normal weight (NW), overweight (OW) and obese (OB) T2DM patients.

Methods

Ninety-four patients (aged 54 ± 8 years) with long-standing (median 10 years), treated diabetes (median HbA1c = 8.6%), who were NW (15), OW (64) or OB (15) based on BMI, underwent LII-SG. Insulin sensitivity and parameters of ß-cell function were measured from an Oral Glycaemic Tolerance Test pre- and post-operatively.

Results

At a median of 13.4 months post-operatively, weight loss averaged 9.4 ± 1.3, 16.8 ± 0.8 and 23.2 ± 1.7 kg in NW, OW and OB subjects, respectively (p < 0.0001). Insulin sensitivity was fully restored (395 [108] vs 208 [99] ml min−1 m−2), fasting insulin secretion rate decreased (68 [52] vs 146 [120] pmol min−1 m−2) and total insulin output increased (52 [26] vs 39 [28] nmol m−2, all p ≤ 0.001). ß-cell glucose sensitivity doubled (37 [33] vs 18 [24] mol min−1 m−2 mM−1, p < 0.0001). The only parameter predicting remission of diabetes was a lower baseline insulin sensitivity (p = 0.005).

Conclusions

LII-SG induced changes on T2DM by mechanisms in part distinct from weight loss, principally involving restoration of insulin sensitivity and improvement of ß-cell function.

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Disclosure

Financial support was provided by institutional funds and by a grant (PRIN prot. 2005067481) from the Italian Ministry of Research and Education.

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Authors and Affiliations

  1. Department of Surgery, Hospital de Especialidades, Av. 136, no. 961, 14 andar, Setor Marista, 74.093-250, Goiânia, Goiás, Brazil

    Aureo Ludovico De Paula & Alessandro R. Stival

  2. Department of Internal Medicine, University of Pisa, Pisa, Italy

    Elza Muscelli & Ele Ferrannini

  3. Department of Endocrinology, University of São Paulo, São Paulo, Brazil

    Alfredo Halpern

  4. National Research Council Institute of Biochemical Engineering, Padova, Italy

    Andrea Mari

  5. Catholic University of Goias, Goiânia, Goiás, Brazil

    Carolina C. L. DePaula & Sergio Vencio

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  1. Aureo Ludovico De Paula
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  2. Alessandro R. Stival
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  3. Alfredo Halpern
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  4. Carolina C. L. DePaula
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  5. Andrea Mari
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  8. Ele Ferrannini
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Correspondence to Aureo Ludovico De Paula.

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De Paula, A.L., Stival, A.R., Halpern, A. et al. Improvement in Insulin Sensitivity and Β-Cell Function Following Ileal Interposition with Sleeve Gastrectomy in Type 2 Diabetic Patients: Potential Mechanisms. J Gastrointest Surg 15, 1344–1353 (2011). https://doi.org/10.1007/s11605-011-1550-6

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  • DOI: https://doi.org/10.1007/s11605-011-1550-6

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