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Long-Term Effects of Bariatric Surgery on Meal Disposal and β-Cell Function in Diabetic and Nondiabetic Patients

Gastric bypass surgery leads to marked improvements in glucose tolerance and insulin sensitivity in obese type 2 diabetes (T2D); the impact on glucose fluxes in response to a physiological stimulus, such as a mixed meal test (MTT), has not been determined. We administered an MTT to 12 obese T2D pati...

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Autores principales: Camastra, Stefania, Muscelli, Elza, Gastaldelli, Amalia, Holst, Jens J., Astiarraga, Brenno, Baldi, Simona, Nannipieri, Monica, Ciociaro, Demetrio, Anselmino, Marco, Mari, Andrea, Ferrannini, Ele
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806605/
https://www.ncbi.nlm.nih.gov/pubmed/23835342
http://dx.doi.org/10.2337/db13-0321
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author Camastra, Stefania
Muscelli, Elza
Gastaldelli, Amalia
Holst, Jens J.
Astiarraga, Brenno
Baldi, Simona
Nannipieri, Monica
Ciociaro, Demetrio
Anselmino, Marco
Mari, Andrea
Ferrannini, Ele
author_facet Camastra, Stefania
Muscelli, Elza
Gastaldelli, Amalia
Holst, Jens J.
Astiarraga, Brenno
Baldi, Simona
Nannipieri, Monica
Ciociaro, Demetrio
Anselmino, Marco
Mari, Andrea
Ferrannini, Ele
author_sort Camastra, Stefania
collection PubMed
description Gastric bypass surgery leads to marked improvements in glucose tolerance and insulin sensitivity in obese type 2 diabetes (T2D); the impact on glucose fluxes in response to a physiological stimulus, such as a mixed meal test (MTT), has not been determined. We administered an MTT to 12 obese T2D patients and 15 obese nondiabetic (ND) subjects before and 1 year after surgery (10 T2D and 11 ND) using the double-tracer technique and modeling of β-cell function. In both groups postsurgery, tracer-derived appearance of oral glucose was biphasic, a rapid increase followed by a sharp drop, a pattern that was mirrored by postprandial glucose levels and insulin secretion. In diabetic patients, surgery lowered fasting and postprandial glucose levels, peripheral insulin sensitivity increased in proportion to weight loss (∼30%), and β-cell glucose sensitivity doubled but did not normalize (compared with 21 nonsurgical obese and lean controls). Endogenous glucose production, however, was less suppressed during the MMT as the combined result of a relative hyperglucagonemia and the rapid fall in plasma glucose and insulin levels. We conclude that in T2D, bypass surgery changes the postprandial response to a dumping-like pattern and improves glucose tolerance, β-cell function, and peripheral insulin sensitivity but worsens endogenous glucose output in response to a physiological stimulus.
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spelling pubmed-38066052014-11-01 Long-Term Effects of Bariatric Surgery on Meal Disposal and β-Cell Function in Diabetic and Nondiabetic Patients Camastra, Stefania Muscelli, Elza Gastaldelli, Amalia Holst, Jens J. Astiarraga, Brenno Baldi, Simona Nannipieri, Monica Ciociaro, Demetrio Anselmino, Marco Mari, Andrea Ferrannini, Ele Diabetes Original Research Gastric bypass surgery leads to marked improvements in glucose tolerance and insulin sensitivity in obese type 2 diabetes (T2D); the impact on glucose fluxes in response to a physiological stimulus, such as a mixed meal test (MTT), has not been determined. We administered an MTT to 12 obese T2D patients and 15 obese nondiabetic (ND) subjects before and 1 year after surgery (10 T2D and 11 ND) using the double-tracer technique and modeling of β-cell function. In both groups postsurgery, tracer-derived appearance of oral glucose was biphasic, a rapid increase followed by a sharp drop, a pattern that was mirrored by postprandial glucose levels and insulin secretion. In diabetic patients, surgery lowered fasting and postprandial glucose levels, peripheral insulin sensitivity increased in proportion to weight loss (∼30%), and β-cell glucose sensitivity doubled but did not normalize (compared with 21 nonsurgical obese and lean controls). Endogenous glucose production, however, was less suppressed during the MMT as the combined result of a relative hyperglucagonemia and the rapid fall in plasma glucose and insulin levels. We conclude that in T2D, bypass surgery changes the postprandial response to a dumping-like pattern and improves glucose tolerance, β-cell function, and peripheral insulin sensitivity but worsens endogenous glucose output in response to a physiological stimulus. American Diabetes Association 2013-11 2013-10-18 /pmc/articles/PMC3806605/ /pubmed/23835342 http://dx.doi.org/10.2337/db13-0321 Text en © 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
spellingShingle Original Research
Camastra, Stefania
Muscelli, Elza
Gastaldelli, Amalia
Holst, Jens J.
Astiarraga, Brenno
Baldi, Simona
Nannipieri, Monica
Ciociaro, Demetrio
Anselmino, Marco
Mari, Andrea
Ferrannini, Ele
Long-Term Effects of Bariatric Surgery on Meal Disposal and β-Cell Function in Diabetic and Nondiabetic Patients
title Long-Term Effects of Bariatric Surgery on Meal Disposal and β-Cell Function in Diabetic and Nondiabetic Patients
title_full Long-Term Effects of Bariatric Surgery on Meal Disposal and β-Cell Function in Diabetic and Nondiabetic Patients
title_fullStr Long-Term Effects of Bariatric Surgery on Meal Disposal and β-Cell Function in Diabetic and Nondiabetic Patients
title_full_unstemmed Long-Term Effects of Bariatric Surgery on Meal Disposal and β-Cell Function in Diabetic and Nondiabetic Patients
title_short Long-Term Effects of Bariatric Surgery on Meal Disposal and β-Cell Function in Diabetic and Nondiabetic Patients
title_sort long-term effects of bariatric surgery on meal disposal and β-cell function in diabetic and nondiabetic patients
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806605/
https://www.ncbi.nlm.nih.gov/pubmed/23835342
http://dx.doi.org/10.2337/db13-0321
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