Restored insulin inhibition on insulin secretion in nondiabetic severely obese patients after weight loss induced by bariatric surgery

Abstract

OBJECTIVE:To examine the impact of important weight loss on insulin inhibition of its own secretion during experimentally induced hyperinsulinemia under euglycemic conditions. DESIGN: Longitudinal, clinical intervention studyFbariatric surgery (vertical banded gastroplastyFgastric bypassFCapella technique), re-evaluation after 4 and 14 months. SUBJECTS: Nine obese patients class III (BMI ¼ 54.672.6 kg/m 2 ) and nine lean subjects (BMI ¼ 22.770.7 kg/m 2 ). MEASUREMENTS: Euglycemic hyperinsulinemic clamp (insulin infusion: 40 mU/min m 2 ), C-peptide plasma levels, electrical bioimpedance methodology, and oral glucose tolerance test (OGTT). RESULTS: BMI was reduced in the follow-up: 44.572.2 and 33.971.5 kg/m 2 at 4 and 14 months. Insulin-induced glucose uptake was markedly reduced in obese patients (19.571.9 mmol/min kg FFM) and improved with weight loss, but in the third study, it was still lower than that observed in controls (35.974.0 vs 52.972.2 mmol/min kg FFM). Insulin-induced inhibition of its own secretion was blunted in obese patients (19.975.7%, relative to fasting values), and completely reversed to values similar to that of lean ones in the second and third studies (À60.874.2 and À54.076.1%, respectively). CONCLUSION: Weight loss in severe obesity improved insulin-induced glucose uptake, and completely normalized the insulin inhibition on its own secretion.

Independent Evolution of Heart Autonomic Function and Insulin Sensitivity During Weight Loss

“…Biliopancreatic diversion, a bariatric surgical intervention inducing weight loss mainly by a malabsorptive mechanism, leads to an improvement of insulin resistance which overcomes the extent due to the reduction of body weight (20). This effect is different from the one produced by gastric bypass, which, in normoglycemic subjects, increases insulin sensitivity mainly, but not exclusively, in function of the weight, as indicated by other authors (20,21) and confirmed by the present study. It would be of great interest to investigate the cardiac autonomic regulation in patients who underwent a biliopancreatic diversion, to confirm the independent post-op evolution of insulin sensitivity and cardiac autonomic function.…”

Effects of Sleeve Gastrectomy and Medical Treatment for Obesity on Glucagon-like Peptide 1 Levels and Glucose Homeostasis in Non-diabetic Subjects

“…This change has been observed after diet and some bariatric procedures [22]. Pereira et al [23] described this phenomenon in nine patients at 6 and 14 months after undergoing verticalbanded gastroplasty-gastric bypass procedure. Jimenez et al [24] observed a normalisation of the insulin response at 3and 12 months following vertical gastroplasty, and Letiexhe et al [25] reported a similar finding in 12 obese non-diabetic subjects at 8 months after vertical-banded gastroplasty.…”

Comparative analysis of LSG versus LRYGBP bariatric surgery in management of morbid obesity and type 2 diabetes mellitus in terms of percentage weight loss and T2DM resolution

“…Other studies which also has glycemic control are as follows. 1,2,4,6,[8][9][10]12,14,[16][17][18][19]21,22 Type of surgery in DM in 65% SG was done & in 35%. RYGB was done with similar result in glycemic control in both surgeries.…”