title: Bileopancreatic diversion with duodenal switch lowers both early and late phases of glucose, insulin and proinsulin responses after meal.
abstract: BACKGROUND
  Hyperproinsulinemia is associated with obesity and type 2 diabetes. We explored the after-meal dynamics of proinsulin and insulin and postprandial effects on glucose and lipids in patients treated with bileopancreatic diversion with duodenal switch (BPD-DS) surgery compared with normal-weight controls [body mass index (BMI)+/-SD, 23.2 +/- 2.4 kg/m(2)].
  
  
  METHODS
  Ten previously morbidly obese (BMI+/-SD, 53.5 +/- 3.8 kg/m(2)) patients free from diabetes who had undergone BPD-DS (BMI+/-SD, 29.0 +/- 5.2 kg/m(2)) 2 years earlier were recruited. A standardised meal (2400 kJ) was ingested, and glucose, proinsulin, insulin, free fatty acids and triglycerides (TGs) were determined during 180 min. Follow-up characteristics yearly on glucose, lipids, creatinine and uric acid over 3 years after BPD-DS are presented.
  
  
  RESULTS
  Fasting glucose and insulin were lower, 0.4 mmol/L and 4.6 pmol/L, respectively, in the BPD-DS group despite higher BMI. Fasting proinsulin was similar in both groups. Postprandial area under the curve (AUC) for glucose, proinsulin and insulin did not differ between the two groups (p = 0.106-734). Postprandial changes in glucose, proinsulin and insulin were essentially similar but absolute concentrations of proinsulin and insulin were lower in the later phases in the BPD-DS group (p = 0.052-0.001). Postprandial AUC for TGs was lower in the BPD-DS group (p = 0.005). Postprandial changes in TGs were lowered in the intermediate phase (p = 0.07-0.08) and in the late phase (0.002). Follow-up data showed markedly lowered creatinine and uric acid after BPD-DS.
  
  
  CONCLUSIONS
  BPD-DS surgery induces a large weight loss and lowers, close to normal, postprandial responses of glucose, proinsulin and insulin but with marked lowering of TGs.
authors.affiliation: Department of Public Health and Caring Sciences/Geriatrics, Uppsala University Hospital, Uppsala Science Park, 75185 Uppsala, Sweden. hans-erik.johansson@pubcare.uu.se
authors.forename: Hans-Erik
authors.initials: HE
authors.lastname: Johansson
authors.forename: Arvo
authors.initials: A
authors.lastname: Haenni
authors.forename: F Anders
authors.initials: FA
authors.lastname: Karlsson
authors.forename: Britt
authors.initials: B
authors.lastname: Edén-Engström
authors.forename: Margareta
authors.initials: M
authors.lastname: Ohrvall
authors.forename: Magnus
authors.initials: M
authors.lastname: Sundbom
authors.forename: Björn
authors.initials: B
authors.lastname: Zethelius
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods*; D001774:Blood Chemical Analysis / Q000706:statistics & numerical data; D001786:Blood Glucose; D005227:Fatty Acids / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D019518:Postprandial Period; D011384:Proinsulin / Q000097:blood; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D005227:Fatty Acids; D007328:Insulin; D014280:Triglycerides; D011384:Proinsulin