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Insulin resistance and beta cell function before and after sleeve gastrectomy in obese patients with impaired fasting glucose or type 2 diabetes

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Abstract

Background

Pathophysiology of type 2 diabetes (T2D) includes insulin resistance (IR) and insufficient insulin secretion. Remission in obese patients can be achieved through surgically induced weight loss. Sleeve gastrectomy is a novel technique for the treatment of morbid obesity, and its effects on the metabolic syndrome and T2D have not yet been fully understood.

Methods

From February 2008 to July 2010, sleeve gastrectomy as stand-alone treatment for severe or morbid obesity was performed in 23 patients with T2D or impaired fasting glucose (IFG). No postoperative complications occurred and patients were dismissed from hospital on day 2 after surgery. Body mass index (BMI), fasting blood glucose (FBG) and fasting insulin were determined before and up to 24 months after surgery. IR and beta cell function were calculated using the modified homeostasis model assessment (HOMA2).

Results

BMI, FBG and fasting insulin improved significantly as early as 3 months after surgery. Threefold increased preoperative insulin resistance (3.05) decreased to near-normal values (1.14) during the same period. Interestingly, overall beta cell function diminished at 12 months of follow-up (79.6 %), in comparison with preoperative values (117.8 %). Patients with a markedly reduced preoperative beta cell function (<40 %) did not achieve a complete remission after surgery.

Conclusions

In obese patients with T2D and IFG, commonly characterized by an augmented beta cell function and an increased insulin resistance, sleeve gastrectomy induces remission through reduction of insulin resistance. Preoperative IR and beta cell function calculated by HOMA2 deserve further studies in patients undergoing metabolic surgery.

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Notes

  1. One patient with BMI < 35 kg/m2 at date of surgery due to standard preoperative diet.

  2. One patient on oral antidiabetics with fasting glycemia <100 mg/dl.

References

  1. DeFronzo RA (1992) Pathogenesis of type 2 (non-insulin dependent) diabetes mellitus: a balanced overview. Diabetologia 35:389–397

    Article  CAS  PubMed  Google Scholar 

  2. Seppälä-Lindroos A, Vehkavaara S, Häkkinen A-M, Goto T, Westerbacka J, Sovijärvi A et al (2002) Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men. J Clin Endocrinol Metab 87:3023–3028

    Article  PubMed  Google Scholar 

  3. Guo Z (2007) Intramyocellular lipid kinetics and insulin resistance. Lipids Health Dis 6:18

    Article  PubMed Central  PubMed  Google Scholar 

  4. Jiang G, Zhang BB (2003) Glucagon and regulation of glucose metabolism. Am J Physiol Endocrinol Metab 284:E671–E678

    CAS  PubMed  Google Scholar 

  5. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ et al (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122(248–256):e5

    PubMed  Google Scholar 

  6. Le Roux CW, Aylwin SJB, Batterham RL, Borg CM, Coyle F, Prasad V et al (2006) Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg 243:108–114

    Article  PubMed Central  PubMed  Google Scholar 

  7. DeFronzo RA, Tobin JD, Andres R (1979) Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 237:E214–E223

    CAS  PubMed  Google Scholar 

  8. Bonora E, Targher G, Alberiche M, Bonadonna RC, Saggiani F, Zenere MB et al (2000) 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 23:57–63

    Article  CAS  PubMed  Google Scholar 

  9. Benaiges D, Goday A, Ramon JM, Hernandez E, Pera M, Cano JF (2011) Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis (in press)

  10. De Gordejuela AGR, Pujol Gebelli J, García NVNV, Alsina EFF, Medayo LS, Masdevall Noguera C (2011) Is sleeve gastrectomy as effective as gastric bypass for remission of type 2 diabetes in morbidly obese patients? Surg Obes Relat Dis 7:506–509

    Article  PubMed  Google Scholar 

  11. Levy JC, Matthews DR, Hermans MP (1998) Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care 21:2191–2192

    Article  CAS  PubMed  Google Scholar 

  12. Reaven GM, Banting lecture (1988) Role of insulin resistance in human disease. Diabetes 1988(37):1595–1607

    Article  Google Scholar 

  13. Martin BC, Warram JH, Krolewski AS, Bergman RN, Soeldner JS, Kahn CR (1992) Role of glucose and insulin resistance in development of type 2 diabetes mellitus: results of a 25-year follow-up study. Lancet 340:925–929

    Article  CAS  PubMed  Google Scholar 

  14. Facchini FS, Hua N, Abbasi F, Reaven GM (2001) Insulin resistance as a predictor of age-related diseases. J Clin Endocrinol Metab 86:3574–3578

    Article  CAS  PubMed  Google Scholar 

  15. Rizzello M, Abbatini F, Casella G, Alessandri G, Fantini A, Leonetti F et al (2010) Early postoperative insulin-resistance changes after sleeve gastrectomy. Obes Surg 20:50–55

    Article  PubMed  Google Scholar 

  16. Meier JJ, Gallwitz B, Salmen S, Goetze O, Holst JJ, Schmidt WE et al (2003) 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 88:2719–2725

    Article  CAS  PubMed  Google Scholar 

  17. Perseghin G, Scifo P, De Cobelli F, Pagliato E, Battezzati A, Arcelloni C et al (1999) Intramyocellular triglyceride content is a determinant of in vivo insulin resistance in humans: a 1H-13C nuclear magnetic resonance spectroscopy assessment in offspring of type 2 diabetic parents. Diabetes 48:1600–1606

    Article  CAS  PubMed  Google Scholar 

  18. Utzschneider KM, Kahn SE (2006) Review: the role of insulin resistance in nonalcoholic fatty liver disease. J Clin Endocrinol Metab 91:4753–4761

    Article  CAS  PubMed  Google Scholar 

  19. Bhat G, Baba CS, Pandey A, Kumari N, Choudhuri G (2012) Life style modification improves insulin resistance and liver histology in patients with non-alcoholic fatty liver disease. World J Hepatol 4:209–217

    Article  PubMed Central  PubMed  Google Scholar 

  20. Petersen KF, Dufour S, Befroy D, Lehrke M, Hendler RE, Shulman GI (2005) Reversal of nonalcoholic hepatic steatosis, hepatic insulin resistance, and hyperglycemia by moderate weight reduction in patients with type 2 diabetes. Diabetes 54:603–608

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Mari A, Tura A, Natali A, Anderwald C, Balkau B, Lalic N et al (2011) Influence of hyperinsulinemia and insulin resistance on in vivo β-cell function: their role in human β-cell dysfunction. Diabetes 60:3141–3147

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Prentki M, Nolan CJ (2006) Islet beta cell failure in type 2 diabetes. J Clin Invest 116:1802–1812

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Butler AE, Janson J, Bonner-Weir S, Ritzel R, Rizza RA, Butler PC (2003) Beta-cell deficit and increased beta-cell apoptosis in humans with type 2 diabetes. Diabetes 52:102–110

    Article  CAS  PubMed  Google Scholar 

  24. Prentki M, Joly E, El-Assaad W, Roduit R (2002) Malonyl-CoA signaling, lipid partitioning, and glucolipotoxicity: role in beta-cell adaptation and failure in the etiology of diabetes. Diabetes 51(Suppl 3):S405–S413

    Article  CAS  PubMed  Google Scholar 

  25. Akash MSH, Rehman K, Chen S (2013) Role of inflammatory mechanisms in pathogenesis of type 2 diabetes mellitus. J Cell Biochem 114:525–531

    Article  CAS  PubMed  Google Scholar 

  26. Jørgensen NB, Dirksen C, Bojsen-Møller KN, Jacobsen SH, Worm D, Hansen DL et al (2013) Exaggerated glucagon-like peptide 1 response is important for improved β-cell function and glucose tolerance after Roux-en-Y gastric bypass in patients with type 2 diabetes. Diabetes 62:3044–3052

    Article  PubMed Central  PubMed  Google Scholar 

  27. Marinari GM, Papadia FS, Briatore L, Adami G, Scopinaro N (2006) Type 2 diabetes and weight loss following biliopancreatic diversion for obesity. Obes Surg 16:1440–1444

    Article  PubMed  Google Scholar 

  28. De Paula AL, Stival AR, Macedo A, Ribamar J, Mancini M, Halpern A et al (2010) Prospective randomized controlled trial comparing 2 versions of laparoscopic ileal interposition associated with sleeve gastrectomy for patients with type 2 diabetes with BMI 21–34 kg/m2. Surg Obes Relat Dis 6:296–304

    Article  PubMed  Google Scholar 

  29. Strader AD, Vahl TP, Jandacek RJ, Woods SC, D’Alessio DA, Seeley RJ (2005) Weight loss through ileal transposition is accompanied by increased ileal hormone secretion and synthesis in rats. Am J Physiol Endocrinol Metab 288:E447–E453

    Article  CAS  PubMed  Google Scholar 

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Disclosures

Hans Eickhoff, Ana Guimarães, Teresa Louro, Raquel Seiça, and Francisco Castro e Sousa have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Obesity Center, Hospital de Santiago, EN 10, km 37, 2900-722, Setúbal, Portugal

    Hans Eickhoff & Ana Guimarães

  2. Institute of Physiology, Faculty of Medicine, University of Coimbra, Polo III, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal

    Hans Eickhoff, Teresa M. Louro & Raquel M. Seiça

  3. Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Polo III, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal

    Teresa M. Louro & Raquel M. Seiça

  4. Department of Surgery A, University Hospital of Coimbra, Rua Fonseca Pinto, 3000-075, Coimbra, Portugal

    Francisco Castro e Sousa

  5. Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal

    Francisco Castro e Sousa

Authors
  1. Hans Eickhoff
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  2. Ana Guimarães
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  3. Teresa M. Louro
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  4. Raquel M. Seiça
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  5. Francisco Castro e Sousa
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Corresponding author

Correspondence to Hans Eickhoff.

Additional information

All patients were treated at the Obesity Center of Hospital de Santiago, Setúbal, Portugal.

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Eickhoff, H., Guimarães, A., Louro, T.M. et al. Insulin resistance and beta cell function before and after sleeve gastrectomy in obese patients with impaired fasting glucose or type 2 diabetes. Surg Endosc 29, 438–443 (2015). https://doi.org/10.1007/s00464-014-3675-7

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  • DOI: https://doi.org/10.1007/s00464-014-3675-7

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