title: Insulin sensitivity is related to glycemic control in type 2 diabetes and diabetes remission after Roux-en Y gastric bypass.
abstract: BACKGROUND
  After initial onset, adequate glycemic control in patients with type 2 diabetes (T2DM) presents a continuing challenge even with aggressive pharmacologic treatment, and longer disease duration is associated with poorer resolution in response to Roux-en Y gastric bypass (RYGB). Skeletal muscle insulin sensitivity is an important determinant of glycemic control. We investigated whether skeletal muscle insulin sensitivity is predictive of T2DM resolution with RYGB and is in general lower in patients with longer-duration T2DM.
  
  
  METHODS
  Insulin sensitivity (SI) and the acute response to glucose (AIRg) were calculated by MINMOD analysis from glucose and insulin obtained during a modified frequently sampled intravenous glucose tolerance test.
  
  
  RESULTS
  Pre-RYGB SI and duration but not AIRg were predictive of T2DM resolution by RYGB. In addition, HbA1c was greater and SI and AIRg lower in long- (8+ years) compared with short-duration (1- to 7-year) T2DM. Multiple linear regression analysis demonstrated that SI explained 32% and AIRg 21% of the variance in HbA1c, respectively.
  
  
  CONCLUSIONS
  The current results suggest that pre-RYGB SI is predictive of T2DM resolution after RYGB, skeletal muscle insulin sensitivity and β-cell function worsen after the onset of T2DM, and low skeletal muscle insulin sensitivity as well as low β cell function contribute to poor glycemic control in T2DM.
authors.affiliation: Department of Health and Kinesiology, Purdue University, West Lafayette, IN. Electronic address: gavin1@purdue.edu.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Gavin
authors.affiliation: Department of Kinesiology, East Carolina University, Greenville, NC; Human Performance Laboratory, East Carolina University, Greenville, NC.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Ernst
authors.affiliation: Department of Kinesiology, East Carolina University, Greenville, NC; Human Performance Laboratory, East Carolina University, Greenville, NC.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Caudill
authors.affiliation: Department of Physiology, East Carolina University, Greenville, NC; East Carolina Diabetes and Obesity Institute at East Carolina University, Greenville, NC.
authors.forename: G Lynis
authors.initials: GL
authors.lastname: Dohm
authors.affiliation: Department of Surgery, East Carolina University, Greenville, NC; East Carolina Diabetes and Obesity Institute at East Carolina University, Greenville, NC.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
authors.affiliation: Department of Medicine, East Carolina University, Greenville, NC; East Carolina Diabetes and Obesity Institute at East Carolina University, Greenville, NC.
authors.forename: Moahad
authors.initials: M
authors.lastname: Dar
authors.affiliation: Department of Kinesiology, West Chester University, West Chester, PA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Reed
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism*; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000378:metabolism; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000601:surgery; D010179:Pancreas / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human