Early Effects of Gastric Banding (LGB) and of Biliopancreatic Diversion (BPD) on Insulin Sensitivity and on Glucose and Insulin Response after OGTT

Abstract

These data indicate an early effect of BPD different from LGB on insulin sensitivity and on glucose and on insulin response to OGTT, mostly independent of weight loss.

Gastric Emptying of Orally Administered Glucose Solutions and Incretin Hormone Responses Are Unaffected by Laparoscopic Adjustable Gastric Banding

“…Also, there were no changes in beta cell secretion, insulin sensitivity (despite a significant weight loss of 4 kg postoperatively), GIP, or glucagon. This is in accordance with Pontiroli et al [29] evaluating glucose homeostasis already 5 days postoperatively showing no differences from preoperative status. This underlines the notion that, in contrast to gastric bypass, LAGB improves glucose homeostasis as a result of calorie restriction and long-term weight loss [42,43].…”

“…The term "resolution" is used inconsistently (although consensus criteria have recently been published [26]) and covers discontinuation of diabetes medications and/or blood glucose levels (HbA 1 c or FPG or non-fasting PG/blood glucose) within "normal range"-the latter expression often not specified. However, in a minority of studies [27][28][29], the OGTT has been used to evaluate glucose homeostasis following LAGB. Except for one study [29] evaluating glucose homeostasis already 5 days postoperatively (showing no differences from preoperatively status), the other studies [27,28] evaluating glucose homeostasis from 6 months to 4 years postoperatively showed improved glucose tolerance in patients with type 2 diabetes and patients with IGT.…”

“…However, in a minority of studies [27][28][29], the OGTT has been used to evaluate glucose homeostasis following LAGB. Except for one study [29] evaluating glucose homeostasis already 5 days postoperatively (showing no differences from preoperatively status), the other studies [27,28] evaluating glucose homeostasis from 6 months to 4 years postoperatively showed improved glucose tolerance in patients with type 2 diabetes and patients with IGT. But this-apparently beneficial-effect of LAGB could be misinterpreted if the operation caused alternations in the rate of gastric emptying.…”

Effects of Bariatric Surgery on Glucose Homeostasis and Type 2 Diabetes

“…95 The effect of LAGB and RYGB on insulin sensitivity derived from oral glucose or meal ingestion when weight loss is ≤11% is unclear because of different results among studies. 79,80,82,106,110,111 In contrast, a consistent decrease in glucose and insulin AUCs is observed early after BPD (1–4 weeks after surgery and 4%–6% weight loss). 110,112–114 …”

“…After minimal to moderate weight loss (<10%), which occurs early after surgery, the total insulin response to glucose or mixed meal ingestion is usually decreased after BPD, 110,112–114 but not after LAGB, 110 vertical banded gastroplasty, 108 or RYGB, 50,79,90,106,111 whereas a decrease 90 or no change 105 has been observed 1 week after LSG (5–6% weight loss). In addition, the shape of the insulin response curve is different after RYGB and LSG than after LAGB, with a faster rise in insulin concentration after oral glucose or meal ingestion, a greater insulin peak, and a steeper decline thereafter.…”