title: Changes in insulin sensitivity and secretion after sleeve gastrectomy.
abstract: BACKGROUND
  Sleeve gastrectomy is indicated for the treatment of obesity and related co-morbidity including diabetes. The dynamic changes in insulin secretion and sensitivity after sleeve gastrectomy are unknown.
  
  
  METHODS
  Whole-body insulin sensitivity was measured by the euglycaemic hyperinsulinaemic clamp technique, and insulin secretion by C-peptide deconvolution after an oral glucose tolerance test (OGTT), before and 3, 6 and 12 months after sleeve gastrectomy in morbidly obese subjects. The time course of glucagon-like peptide (GLP) 1, as a marker of insulin secretion following OGTT, was also assessed.
  
  
  RESULTS
  Ten patients were included in the study. Median (range) baseline insulin sensitivity (M-value) increased from 84.0 (20.2-131.4) mmol per kg per min at baseline to 122.8 (99.0-179.3) mmol per kg per min at 12 months after surgery (P = 0.015). Fasting insulin sensitivity, measured by homeostatic model assessment of insulin resistance, which represents a surrogate index of hepatic insulin resistance, decreased from 3.3 (1.9-5.5) to 0.7 (0.5-1.1) mg/dl · µunits/ml (P < 0.001). Total insulin secretion, measured as incremental area under the curve (AUC), after OGTT decreased from 360.4 (347.9-548.0) to 190.1 (10.1-252.0) mmol/l · 180 min at 12 months (P = 0.011). The AUC for GLP-1 increased from 258.5 (97.5-552.6) to 5531.8 (4143.0-7540.9) pmol/l · 180 min at 12 months after sleeve gastrectomy (P < 0.001). In multiple regression analysis, 51 per cent of the M-value variability was explained by GLP-1 secretion.
  
  
  CONCLUSIONS
  Sleeve gastrectomy improved insulin sensitivity and reduced insulin secretion within 6 months after surgery. Although there was a correlation between insulin sensitivity and bodyweight, the major driver of the improvement in insulin sensitivity was GLP-1 secretion.
authors.affiliation: Surgical Sciences Department, Medical School 'Sapienza' University, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Casella
authors.affiliation: Surgical Sciences Department, Medical School 'Sapienza' University, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Soricelli
authors.affiliation: Surgical Sciences Department, Medical School 'Sapienza' University, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Castagneto-Gissey
authors.affiliation: Surgical Sciences Department, Medical School 'Sapienza' University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Redler
authors.affiliation: Surgical Sciences Department, Medical School 'Sapienza' University, Rome, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Basso
authors.affiliation: Department of Internal Medicine, Catholic University of Rome, Rome, Italy.|Department of Diabetes and Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College, London, UK.|Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Mingrone
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance / Q000502:physiology*; D000078790:Insulin Secretion; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin