Recovery of the incretin effect in type 2 diabetic patients after biliopancreatic diversion.
BACKGROUND
Bariatric surgery often results in remission of the diabetic state in obese patients. Increased incretin effect seems to play an important role in the glycemic improvements after Roux-en-Y gastric bypass, but the impact of biliopancreatic diversion (BPD) remains unexplored.


OBJECTIVE
The objective was to elucidate the effect of BPD on the incretin effect and its interplay with beta-cell function and insulin sensitivity (IS) in obese subjects with type 2 diabetes (T2DM).


METHODS
Twenty-three women were studied: a control group of 13 lean, normal glucose-tolerant women (lean NGT) studied once and 10 obese patients with T2DM studied before, 1 and 12 months after BPD.


METHODS
The ObeseT2DM group underwent BPD.


METHODS
The main outcome measure was the change in incretin effect as measured by the isoglycemic intravenous glucose infusion test. Secondary outcomes encompassed IS and beta-cell function.


RESULTS
At baseline, the incretin effect was lower in obese T2DM compared to lean NGT (P < .05). One month after BPD, the incretin effect was not changed, but at 12 months it reached the level of the lean NGT group (P > .05). IS improved (P < .05) 1 month after BPD and at 12 months it resembled the levels of the lean NGT group. Insulin secretory rate and beta-cell glucose sensitivity increased after BPD and achieved levels similar to lean NGT group 1 month after BPD and even higher levels at 12 months (P < .05).


CONCLUSIONS
BPD has no acute impact on the reduced incretin effect, but 12 months after surgery the incretin effect normalizes alongside normalization of glucose control, IS and beta-cell function.
Laboratory of Investigation on Metabolism and Diabetes (F.S.N., A.C.J.V., J.C.P., B.G.), Gastrocentro, School of Applied Sciences (A.C.J.V.), Department of Surgery (J.C.P., E.A.C.), Diabetic Surgery Unit, State University of Campinas, Campinas, 13081-970 São Paulo, Brazil; Center for Diabetes Research (F.K.K.), Department of Medicine, Gentofte Hospital, University of Copenhagen, DK-2100 Hellerup, Denmark; and Institute of Biomedical Engineering of the Italian National Research Council (A.T.), I-35127 Padova, Italy.
Fernanda S
FS
Novaes
Ana C J
AC
Vasques
José C
JC
Pareja
Filip K
FK
Knop
Andrea
A
Tura
Élinton A
ÉA
Chaim
Bruno
B
Geloneze
D000328:Adult; D015904:Biliopancreatic Diversion; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D054795:Incretins / Q000378:metabolism*; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance / Q000502:physiology; D050417:Insulin-Secreting Cells / Q000502:physiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D016896:Treatment Outcome
D001786:Blood Glucose; D002096:C-Peptide; D054795:Incretins; D007328:Insulin