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Diabetes Remission and Insulin Secretion After Gastric Bypass in Patients with Body Mass Index <35 kg/m2
Obesity Surgery, 05/11/2011
Lee WJ et al. – Laparoscopic gastric bypass facilitates immediate improvement in the glucose metabolism of inadequately controlled non–severe obese type 2 diabetes mellitus (T2DM) patients, and the benefit is sustained up to 2 years after surgery. The benefit is regulated by the decrease in insulin resistance, increase in early insulin response, and total insulin secretion to glucose load.
Methods- 62 consecutive patients with T2DM and a BMI of 23–35 kg/m2 underwent gastric bypass.
- Data were prospectively collected before surgery and 1, 4, 12, 26, and 52 weeks and 2 years after surgery.
- Insulin secretion was measured by insulinogenic index and area under the curve (AUC) during a standard oral glucose tolerance test (OGTT).
- Remission of type 2 diabetes was defined as fasting glucose level <110 mg/dl and HbA1c <6.0% without any glycemic therapy.
- Of the 62 patients, 24 were men and 38 were women (age 43.1±10.8 years).
- Their preoperative characteristics were as follows: BMI 30.1±3.3 kg/m2, waist circumference 99.6±9.6 cm, C-peptide 3.1±1.4 ng/ml, and duration of T2DM 5.4±5.1 years.
- The mean BMI decreased postoperatively to 22.6±2.3 kg/m2 in 1 year and 23.0±2.7 kg/m2 in 2 years.
- The mean HbA1c decreased from 9.7±1.9% to 5.8±0.5% in 1 year and 5.9±0.5% in 2 years.
- Complete remission of T2DM was achieved in 57% in 1 year and 55% in 2 years after surgery.
- Before surgery, the OGTT test showed a blunted insulin secretion pattern with an insulinogenic index of 0.1±0.2 and AUC of 2,324±1,015 microIU min/ml.
- In 1 week after surgery, the insulinogenic index increased to 0.16 and AUC decreased to 1,366 microIU min/ml along with a rapid drop of insulin resistance.
- The insulinogenic index and AUC gradually increased to 0.27 and 3,220, respectively, 1 year after surgery and remained stable up to 2 years with a very low insulin resistance.
