Biliopancreatic diversion with duodenal switch improves insulin sensitivity and secretion through caloric restriction.
OBJECTIVE
To assess the rapid improvement of insulin sensitivity and β-cell function following biliopancreatic diversion with duodenal switch (BPD-DS) and determine the role played by caloric restriction in these changes.


METHODS
Standard meals were administrated before and on day 3, 4, and 5 after BPD-DS to measure total caloric intake, glucose excursion, insulin sensitivity, and secretion in matched type 2 diabetes and normoglycemic (NG) subjects. In a second set of study, other subjects with type 2 diabetes had the same meal tests prior to and after a 3-day caloric restriction identical to that observed after BPD-DS and then 3 days after actually undergoing BPD-DS.


RESULTS
Improvement of HOMA-IR occurred at day 3 after BPD-DS in diabetes and after 3 days of caloric restriction. The disposition index (DI) improved rapidly in diabetes after BPD-DS and to a similar extent after caloric restriction. DI was higher and did not change after BPD-DS in NG. Changes in glucagon-like peptide-1, gastric inhibitory peptide, peptide tyrosine tyrosine, ghrelin, and pancreatic polypeptide levels were not associated with modulation of DI in the participants.


CONCLUSIONS
Caloric restriction is the major mechanism underlying the early improvement of insulin sensitivity and β-cell function after BPD-DS in type 2 diabetes.
Department of Medicine, Division of Endocrinology, Centre de recherche clinique Étienne-Le Bel, Université de Sherbrooke, Québec, Canada; Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada.
Charles-Étienne
CÉ
Plourde
Thomas
T
Grenier-Larouche
Dominique
D
Caron-Dorval
Simon
S
Biron
Simon
S
Marceau
Stéfan
S
Lebel
Laurent
L
Biertho
André
A
Tchernof
Denis
D
Richard
André C
AC
Carpentier
D000328:Adult; D015904:Biliopancreatic Diversion; D001786:Blood Glucose / Q000032:analysis; D031204:Caloric Restriction; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004386:Duodenum / Q000601:surgery; D005260:Female; D005749:Gastric Inhibitory Polypeptide / Q000097:blood; D054439:Ghrelin / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D000078790:Insulin Secretion; D050417:Insulin-Secreting Cells / Q000166:cytology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D019894:Peptide YY / Q000097:blood; D010865:Pilot Projects
D001786:Blood Glucose; D054439:Ghrelin; D007328:Insulin; D019894:Peptide YY; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1