title: β-Cell function improvements in grade I/II obese subjects with type 2 diabetes 1 month after biliopancreatic diversion: results from modeling analyses of oral glucose tolerance tests and hyperglycemic clamp studies.
abstract: OBJECTIVE
  To investigate the effect of biliopancreatic diversion (BPD) surgery on β-cell function in grade I and II obese patients with type 2 diabetes using oral and intravenous glucose loads.
  
  
  METHODS
  Sixty-eight women were divided into the following three groups: 19 lean-control (23.0 ± 2.2 kg/m(2)) and 18 obese-control (35.0 ± 4.8 kg/m(2)) subjects with normal glucose tolerance, and 31 obese patients with type 2 diabetes (36.3 ± 3.7 kg/m(2)). Of the 31 diabetic women, 64% underwent BPD (n = 20, BMI: 36.5 ± 3.7 kg/m(2)) and were reassessed 1 month after surgery. Oral glucose tolerance tests and hyperglycemic clamps were performed. Mathematical modeling was used to analyze basal and stimulated β-cell function, insulin sensitivity (IS), hepatic extraction (HE) of insulin, and delay time of β-cell response to a specific plasma glucose concentration.
  
  
  RESULTS
  After BPD, restoration of the basal disposition index (P < 0.001) and improvement of the stimulated disposition indices in oral and intravenous glucose stimulation of the β-cell were observed (P < 0.05). In both dynamic tests, there were no changes in the delay time of β-cell response. IS for oral glucose stimulation (IS(oral)) and intravenous clamp glucose stimulation (IS(clamp)) was completely normalized (P < 0.001). IS(oral) and IS(clamp) increased approximately 5.0-fold and 3.5-fold, respectively (P < 0.01). The HE of insulin increased in the basal (P < 0.05) and stimulated states (P < 0.01).
  
  
  CONCLUSIONS
  β-Cell function, IS, and HE of insulin improved after BPD, which improved glycemic control.
authors.affiliation: Corresponding author: Ana Carolina Junqueira Vasques, anacarolinavasques@yahoo.com.br.
authors.forename: Ana Carolina
authors.initials: AC
authors.lastname: Junqueira Vasques
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Pareja
authors.forename: Maria da Saude
authors.initials: Mda S
authors.lastname: de Oliveira
authors.forename: Fernanda
authors.initials: F
authors.lastname: Satake Novaes
authors.forename: Marcelo
authors.initials: M
authors.lastname: Miranda de Oliveira Lima
authors.forename: Élinton A
authors.initials: ÉA
authors.lastname: Chaim
authors.forename: Francesca
authors.initials: F
authors.lastname: Piccinini
authors.forename: Chiara
authors.initials: C
authors.lastname: Dalla Man
authors.forename: Claudio
authors.initials: C
authors.lastname: Cobelli
authors.forename: Bruno
authors.initials: B
authors.lastname: Geloneze
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D005260:Female; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000150:complications / Q000473:pathology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology; D050417:Insulin-Secreting Cells / Q000502:physiology*; D009765:Obesity / Q000150:complications / Q000601:surgery*; D017697:Premenopause
chemical_list: D001786:Blood Glucose; D007328:Insulin