Skip to main content

Advertisement

SpringerLink
Log in

Early Postoperative Insulin-Resistance Changes After Sleeve Gastrectomy

  • Clinical Report
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Introduction

Biliopancreatic diversion and Gastric bypass are associated with a rapid improvement in insulin resistance few days after surgery. The purpose of this study was to evaluate the short-term effects in insulin resistance following sleeve gastrectomy (SG).

Materials and methods

Between December 2007 and September 2008, 17 consecutive obese type 2 diabetes mellitus patients (three men, mean age 51.1 years, mean BMI 44.7 kg/m2) were submitted to laparoscopic SG. Fasting serum glucose, insulin concentration, and homeostatic model assessment for insulin resistance (HOMA IR) were drawn preoperatively and at 5, 15, 30, and 60 postoperative days. In seven of these patients insulin sensitivity was evaluated on postoperative days 1, 2, 3, and 4. Moreover a control group of three overweight and diabetic patients (one man, mean age 52.1 years and mean BMI 26.8 kg/m2) submitted to laparoscopic cholecystectomy and undergoing the same diet protocol was studied.

Results

In all obese patients, a sharp (5 days) and significant reduction of serum glucose and insulin concentration and HOMA IR values was observed after SG. In seven patients, serum glucose and insulin concentration and HOMA IR values were significantly lower at third postoperative day. At the 15th postoperative day both serum glucose and insulin concentration and HOMA IR remained significantly lower in the absence of significant weight modifications. At 30 and 60 postoperative days, these values remained substantially unchanged in spite of a greater weight loss. In the cholecystectomy patients group, at postoperative day 5, only the serum glucose concentrations were significantly reduced although with the higher values than normal in respect to the preoperative values.

Conclusions

After SG the improvement of insulin action occurred rapidly and independently of EWL. The results of the present study confirm that a hormonal mechanism may contribute to changes in insulin resistance following SG.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. James PT, Rigby N, Leach R, et al. The obesity epidemic, metabolic syndrome and future prevention strategies. Eur J Cardiovasc Prev Rehabil. 2004;11(1):3–8.

    Article  PubMed  Google Scholar 

  2. York DA, Rössner S, Caterson I, et al. Prevention Conference VII: obesity, a worldwide epidemic related to heart disease and stroke: group I: worldwide demographics of obesity. Circulation. 2004;110(18):e463–70.

    Article  PubMed  Google Scholar 

  3. Haslam DW, James WP. Obesity. Lancet. 2005;366(9492):1197–209.

    Article  PubMed  Google Scholar 

  4. Meinders AE, Fogteloo J. Overweight and obesity; recommendations from the National Health Council. Ned Tijdschr Geneeskd. 2003;147(38):1847–51.

    CAS  PubMed  Google Scholar 

  5. Mason EE, Renquist K, Jiang D. Predictors of two obesity complications; diabetes and hypertension. Obes Surg. 1992;2(3):231–7.

    Article  PubMed  Google Scholar 

  6. Kral JG. Morbidity of severe obesity. Surg Clin North Am. 2001;81(5):1039–61.

    Article  CAS  PubMed  Google Scholar 

  7. Sjöström CD, Lissner L, Wedel H, et al. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS intervention study. Obes Res. 1999;7(5):477–85.

    PubMed  Google Scholar 

  8. Eriksson J, Lindström J, Tuomilehto J. Potential for the prevention of type 2 diabetes. Br Med Bull. 2001;60:183–99.

    Article  CAS  PubMed  Google Scholar 

  9. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.

    Article  CAS  PubMed  Google Scholar 

  10. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352(9131):837–853.

  11. Wickremesekera K, Miller G, Naotunne TD, et al. Loss of insulin resistance after Roux-en-Y gastric bypass surgery: a time course study. Obes Surg. 2005;15(4):474–81.

    Article  PubMed  Google Scholar 

  12. Ballantyne GH, Farkas D, Laker S, et al. Short-term changes in insulin resistance following weight loss surgery for morbid obesity: laparoscopic adjustable gastric banding versus laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2006;16(9):1189–97.

    Article  CAS  PubMed  Google Scholar 

  13. Adami GF, Cordera R, Camerini G, et al. Recovery of insulin sensitivity in obese patients at short term after biliopancreatic diversion. J Surg Res. 2003;113(2):217–21.

    Article  CAS  PubMed  Google Scholar 

  14. Sarson DL, Scopinaro N, Bloom SR. Gut hormone changes after jejunoileal (JIB) or biliopancreatic (BPB) bypass surgery for morbid obesity. Int J Obes. 1981;5(5):471–80.

    CAS  PubMed  Google Scholar 

  15. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20(6):859–63.

    Article  CAS  PubMed  Google Scholar 

  16. Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15(10):1469–75.

    Article  PubMed  Google Scholar 

  17. Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16(9):1138–44.

    Article  PubMed  Google Scholar 

  18. Vidal J, Ibarzabal A, Romero F, et al. Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg. 2008;18(9):1077–82.

    Article  CAS  PubMed  Google Scholar 

  19. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84.

    PubMed  Google Scholar 

  20. Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237(6):751–6.

    Article  PubMed  Google Scholar 

  21. Adams TD, Gress RE, Smith MA, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.

    Article  CAS  PubMed  Google Scholar 

  22. Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004;240(2):236–42.

    Article  PubMed  Google Scholar 

  23. Stubbs RS, Wickremesekera SK. Insulin resistance in the severely obese and links with metabolic co-morbidities. Obes Surg. 2002;12(3):343–8.

    Article  PubMed  Google Scholar 

  24. Emoto M, Nishizawa Y, Maekawa K, et al. Homeostasis model assessment as a clinical index of insulin resistance in type 2 diabetic patients treated with sulfonylureas. Diabetes Care. 1999;22(5):818–22.

    Article  CAS  PubMed  Google Scholar 

  25. Bonora E, Targher G, Alberiche M, et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care. 2000;23(1):57–63.

    Article  CAS  PubMed  Google Scholar 

  26. O'Brien PE, Dixon JB, Brown W, et al. The laparoscopic adjustable gastric band (Lap-Band): a prospective study of medium-term effects on weight, health and quality of life. Obes Surg. 2002;12(5):652–60.

    Article  PubMed  Google Scholar 

  27. Meier JJ, Gallwitz B, Salmen S, et al. Normalization of glucose concentrations and deceleration of gastric emptying after solid meals during intravenous glucagon-like peptide 1 in patients with type 2 diabetes. J Clin Endocrinol Metab. 2003;88:2719–25.

    Article  CAS  PubMed  Google Scholar 

  28. Laferrere B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93:2479–85.

    Article  CAS  PubMed  Google Scholar 

  29. 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(5):873–81.

    Article  CAS  PubMed  Google Scholar 

  30. Morinigo R, Vidal J, Lacy AM, et al. Circulating peptide YY, weight loss, and glucose homeostasis after gastric bypass surgery in morbidly obese subjects. Ann Surg. 2008;247:270–5.

    Article  PubMed  Google Scholar 

  31. van den Hoek AM, Heijboer AC, Voshol PJ, et al. Chronic PYY3–36 treatment promotes fat oxidation and ameliorates insulin resistance in C57BL6 mice. Am J Physiol Endocrinol Metab. 2007;292:E238–45.

    Article  PubMed  Google Scholar 

  32. Liou JM, Lin JT, Lee WJ, et al. The serial changes of ghrelin and leptin levels and their relations to weight loss after laparoscopic minigastric bypass surgery. Obes Surg. 2008;18(1):84–9.

    Article  PubMed  Google Scholar 

  33. Kotidis EV, Koliakos G, Papavramidis TS, et al. The effect of biliopancreatic diversion with pylorus-preserving sleeve gastrectomy and duodenal switch on fasting serum ghrelin, leptin and adiponectin levels: is there a hormonal contribution to the weight-reducing effect of this procedure? Obes Surg. 2006;16(5):554–9.

    Article  PubMed  Google Scholar 

  34. Geloneze B, Tambascia MA, Pareja JC, et al. Serum leptin levels after bariatric surgery across a range of glucose tolerance from normal to diabetes. Obes Surg. 2001;11:693–8.

    Article  CAS  PubMed  Google Scholar 

  35. Hickey MS, Pories WJ, MacDonald KG Jr, et al. A new paradigm for type 2 diabetes mellitus: could it be a disease of the foregut? Ann Surg. 1998;227:637–43. discussion 43-4.

    Article  CAS  PubMed  Google Scholar 

  36. Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13(6):861–4.

    Article  CAS  PubMed  Google Scholar 

  37. Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.

    Article  PubMed  Google Scholar 

  38. Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc. 2007;21(10):1810–6.

    Article  PubMed  Google Scholar 

  39. Yada T, Dezaki K, Sone H, et al. Ghrelin regulates insulin release and glycemia: physiological role and therapeutic potential. Curr Diabetes Rev. 2008;4(1):18–23.

    Article  CAS  PubMed  Google Scholar 

  40. Boey D, Heilbronn L, Sainsbury A, et al. Low serum PYY is linked to insulin resistance in first-degree relatives of subjects with type 2 diabetes. Neuropeptides. 2006;40(5):317–24.

    Article  CAS  PubMed  Google Scholar 

  41. Djurhuus CB, Hansen TK, Gravholt C, et al. Circulating levels of ghrelin and GLP-1 are inversely related during glucose ingestion. Horm Metab Res. 2002;34:411–3.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

The authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Surgical–Medical Department for Digestive Diseases, Policlinico “Umberto I”, University “Sapienza”, Viale del Policlinico, 00161, Rome, Italy

    Mario Rizzello, Francesca Abbatini, Giovanni Casella, Giorgio Alessandri, Aldo Fantini & Nicola Basso

  2. Department of Clinical Sciences, Policlinico “Umberto I”, University “Sapienza”, Rome, Italy

    Frida Leonetti

Authors
  1. Mario Rizzello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesca Abbatini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giovanni Casella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giorgio Alessandri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aldo Fantini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frida Leonetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nicola Basso
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicola Basso.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rizzello, M., Abbatini, F., Casella, G. et al. Early Postoperative Insulin-Resistance Changes After Sleeve Gastrectomy. OBES SURG 20, 50–55 (2010). https://doi.org/10.1007/s11695-009-0017-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-009-0017-2

Keywords

Search

Navigation