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Early Mechanisms of Glucose Improvement following Laparoscopic Ileal Interposition Associated with a Sleeve Gastrectomy Evaluated by the Euglycemic Hyperinsulinemic Clamp in Type 2 Diabetic Patients with BMI below 35
Digestive Surgery, 09/06/2011
Vencio S et al. – According to the clamp technique, ileal interposition associated with a sleeve gastrectomy (II–SG) significantly improved insulin sensitivity (IS) and beta–cell function as early as 30 days postoperatively in a type 2 diabetic (T2DM) population with a BMI of 21.9–33.8.
Methods- This was a prospective study of 24 T2DM patients submitted to a 3-hour euglycemic hyperinsulinemic clamp (EHC)- intravenous glucose tolerance test (IVGTT) before and 1 month after laparoscopic ileal interposition associated with a sleeve gastrectomy (LII-SG).
- Mean BMI was 29.0, mean age was 54.8 years and mean duration of T2DM was 10.2 years; insulin therapy was used by 62.5% of the patients.
- Mean BMI decreased from 29.0 to 25.8 (p < 0.001).
- Mean fasting plasma glucose and mean postprandial glucose were 202 and 251.3 mg/dl and dropped to 127.7 and 131.8 mg/dl (p < 0.001), respectively.
- Mean preoperative IS was 1.4 mmol/min/nmol and increased to 2.2 mmol/min/nmol postoperatively (p < 0.001).
- Mean C-peptide AUC was 488 pmol/nmol/ and increased to 777 pmol/nmol (p = 0.37).
- The disposition index increased from 9.4 to 36.4 postoperatively (p = 0.01).