title: 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.
abstract: BACKGROUND
  Laparoscopic ileal interposition associated with a sleeve gastrectomy (LII-SG) is a safe and effective operation for the treatment of type 2 diabetic (T2DM) patients with BMI below 35. The aim of this study was to evaluate insulin sensitivity (IS) and β-cell function using the euglycemic hyperinsulinemic clamp (EHC) with the intravenous glucose tolerance test (IVGTT).
  
  
  METHODS
  This was a prospective study of 24 T2DM patients submitted to a 3-hour EHC-IVGTT before and 1 month after 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.
  
  
  RESULTS
  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(-1)·nmol(-1) and increased to 2.2 mmol· min(-1)·nmol(-1) postoperatively (p < 0.001). Mean C-peptide AUC was 488 pmol·nmol(-1) and increased to 777 pmol· nmol(-1) (p = 0.37). The disposition index increased from 9.4 to 36.4 postoperatively (p = 0.01).
  
  
  CONCLUSIONS
  According to the clamp technique, II-SG significantly improved IS and β-cell function as early as 30 days postoperatively in a T2DM population with a BMI of 21.9-33.8.
authors: Catholic University of Goias, Goiania, Brazil.
authors: Sergio
authors: S
authors: Vencio
authors: Alessandro
authors: A
authors: Stival
authors: Alfredo
authors: A
authors: Halpern
authors: Carolina C L
authors: CC
authors: Depaula
authors: Aureo L
authors: AL
authors: DePaula
mesh_terms: D000328:Adult; D019540:Area Under Curve; D050110:Bariatric Surgery; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005743:Gastrectomy; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D050417:Insulin-Secreting Cells / Q000502:physiology*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000503:physiopathology / Q000601:surgery; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin