title: First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis.
abstract: BACKGROUND
  The aim of this study was to evaluate the possible role of sleeve gastrectomy (SG) per se in the reversibility of diabetes.
  
  
  METHODS
  Insulin secretion and peripheral insulin sensitivity using the intravenous glucose tolerance test (IVGTT) were assessed in 18 obese type 2 diabetic patients and in 10 nondiabetic obese patients before and 3 days after SG, before any food intake and any weight change occurrence. At the same time, ghrelin, GLP-1, and PYY levels were determined.
  
  
  RESULTS
  In diabetic patients who had the disease less than 10.5 years, the first phase of insulin secretion promptly improved after SG. The early insulin area under the curve (AUC) significantly increased at the postoperative IVGTT, indicating an increased glucose-induced insulin secretion. The second phase of insulin secretion (late AUC) significantly decreased after SG in all groups, indicating an improved insulin peripheral sensitivity. In all groups, pre- and postoperatively, intravenous glucose stimulation determined a decrease in ghrelin values and an increase in GLP-1 and PYY values. However, in the group of patients with disease duration >10.5 years, the differences were not significant except for the late insulin AUC. Postoperative basal and intravenous glucose-stimulated ghrelin levels were lower than preoperative levels in all groups of patients. Basal and intravenous stimulated GLP-1 and PYY postoperative values were higher than preoperative levels in all groups.
  
  
  CONCLUSIONS
  Restoration of the first phase of insulin secretion and improved insulin sensitivity in diabetic obese patients immediately after SG, before any food passage through the gastrointestinal tract and before any weight loss, seem to be related to ghrelin, GLP-1, and PYY hormonal changes of possible gastric origin and was neither meal- nor weight-change-related. Duration of the disease up to 10.5 years seems to be a major cut off in the pathophysiological changes induced by SG. A "gastric" hypothesis may be put forward to explain the antidiabetes effect of SG.
authors.affiliation: Surgical-Medical Center for Digestive Diseases, Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico, 00161 Rome, Italy. nicola.basso@uniroma1.it
authors.forename: N
authors.initials: N
authors.lastname: Basso
authors.forename: D
authors.initials: D
authors.lastname: Capoccia
authors.forename: M
authors.initials: M
authors.lastname: Rizzello
authors.forename: F
authors.initials: F
authors.lastname: Abbatini
authors.forename: P
authors.initials: P
authors.lastname: Mariani
authors.forename: C
authors.initials: C
authors.lastname: Maglio
authors.forename: F
authors.initials: F
authors.lastname: Coccia
authors.forename: G
authors.initials: G
authors.lastname: Borgonuovo
authors.forename: M L
authors.initials: ML
authors.lastname: De Luca
authors.forename: R
authors.initials: R
authors.lastname: Asprino
authors.forename: G
authors.initials: G
authors.lastname: Alessandri
authors.forename: G
authors.initials: G
authors.lastname: Casella
authors.forename: F
authors.initials: F
authors.lastname: Leonetti
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D005743:Gastrectomy; D054439:Ghrelin / Q000097:blood*; D052216:Glucagon-Like Peptide 1 / Q000097:blood*; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000601:surgery*; D019894:Peptide YY / Q000097:blood*
chemical_list: D054439:Ghrelin; D007328:Insulin; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1