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Malabsorptive bariatric surgery linked to reduction in effect of intestinal factor
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After malabsorptive bariatric surgery, normalization of insulin sensitivity and first-phase insulin secretion restoration in patients with type 2 diabetes was associated with the reduction of the effect of an intestinal factor resulting from intestinal bypass.
Researchers evaluated nine obese women with type 2 diabetes before and after biliopancreatic diversion and compared them with six women of normal weight.
The oral glucose tolerance test area under the curve was reduced to 0.22 × 103 mmol/L per minute. The insulin AUC was reduced to 1.01 × 104 pmol per 1–1 per minute (P<.02). The C-peptide AUC was reduced to 1.10 × 102 nmol/L per minute (P<.02).
For the IVGTT, the AUC for glucose was reduced to 0.51 × 103 mmol per 1–1 per minute (P<.05). The AUC for insulin was 1.90 × 104 pmol per 1–1 per minute (P<.02) and for C-peptide was 1.54 × 102 nmol per 1–1 per minute.
The disposition index from OGTT data became similar to values in the control group and increased by about 10-fold, according to the study. The disposition index from IVGTT increased by about 3.5-fold.
The reduction for the AUC for glucose-dependent insulinotropic polypeptide was about four times (P<.05); the reduction for glucagon-like peptide 1 was almost triple (P<.001).
“First-phase insulin secretion was restored one month after biliopancreatic diversion; the beta-cell glucose sensitivity was fully normalized; the disposition index was normalized thanks to the normalization of insulin sensitivity and the consequent reduced requirement of insulin secretion; and the increase in the insulin sensitivity estimated by the OGTT minimal model was larger than that estimated by the IVGTT minimal model,” the researchers wrote.
Salinari S. Diabetes Care. 2009;32:375-380.