Obesity Facts (Dec 2016)

Insulin Sensitivity and Secretion in Obese Type 2 Diabetic Women after Various Bariatric Operations

  • Jana Vrbikova,
  • Marie Kunesova,
  • Ioannis Kyrou,
  • Andrea Tura,
  • Martin Hill,
  • Tereza Grimmichova,
  • Katerina Dvorakova,
  • Petra Sramkova,
  • Karin Dolezalova,
  • Olga Lischkova,
  • Josef Vcelak,
  • Vojtech Hainer,
  • Bela Bendlova,
  • Sudhesh Kumar,
  • Martin Fried

DOI
https://doi.org/10.1159/000453000
Journal volume & issue
Vol. 9, no. 6
pp. 410 – 423

Abstract

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Objective: To compare the effects of biliopancreatic diversion (BPD) and laparoscopic gastric banding (LAGB) on insulin sensitivity and secretion with the effects of laparoscopic gastric plication (P). Methods: A total of 52 obese women (age 30-66 years) suffering from type 2 diabetes mellitus (T2DM) were prospectively recruited into three study groups: 16 BPD; 16 LAGB, and 20 P. Euglycemic clamps and mixed meal tolerance tests were performed before, at 1 month and at 6 months after bariatric surgery. Beta cell function derived from the meal test parameters was evaluated using mathematical modeling. Results: Glucose disposal per kilogram of fat free mass (a marker of peripheral insulin sensitivity) increased significantly in all groups, especially after 1 month. Basal insulin secretion decreased significantly after all three types of operations, with the most marked decrease after BPD compared with P and LAGB. Total insulin secretion decreased significantly only following the BPD. Beta cell glucose sensitivity did not change significantly post-surgery in any of the study groups. Conclusion: We documented similar improvement in insulin sensitivity in obese T2DM women after all three study operations during the 6-month postoperative follow-up. Notably, only BPD led to decreased demand on beta cells (decreased integrated insulin secretion), but without increasing the beta cell glucose sensitivity.

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