title: Long-term clinical and functional impact of biliopancreatic diversion on type 2 diabetes in morbidly and non-morbidly obese patients.
abstract: METHODS
  Obesity surgery has been proposed as a treatment option for diabetic patients with body mass index (BMI)<35 kg/m(2), but the efficacy of metabolic surgery has not been conclusively determined.
  
  
  OBJECTIVE
  To evaluate the long-term metabolic outcome of non-morbidly obese (NMO) patients with type 2 diabetes (T2D) after biliopancreatic diversion (BPD).
  
  
  METHODS
  Two groups of T2D patients with different degree of obesity (NMO, 17 cases, BMI 25-35 kg/m(2); and morbidly obese [MO], 13 cases, BMI>35 kg/m(2)) were studied before and at 1 and 5 years after BPD in a university hospital setting. Insulin secretion was assessed by acute insulin response (AIR) to intravenous glucose and by insulinogenic index (IGI).
  
  
  RESULTS
  In all MO patients, T2D was remitted or controlled (1 case) at 1 year and results were maintained at 5 years; AIR (μU/mL) and IGI (μU/mg) improved (P<.001) at 1 year (from .1±3.1 to 18.52±21.9, and from 6.0±8.5 to 9.1±22.8, respectively) with a further increase (to 24.8±25.5 and to 14.3±13.8, respectively) at 5 years. Within the NMO group, T2D was remitted in 1/17 and controlled in 14/17 patients at 1 year, and in 2/17 and in 4/17 patients at 5 years, respectively; AIR (μU/mL) and IGI (μU/mg) remained unchanged throughout the postoperative period (from .31±9.26 to 1.5±2.8 at 1 yr and to .4±3.29 at 5 yr for AIR, and from 2.2±4.9 to 1.3±9.0 at 1 yr and to 2.3±3.3 at 5 yr for IGI).
  
  
  CONCLUSIONS
  After BPD, restoration of β-cell secretion/production plays a pivotal role in determining postoperative T2D remission.
authors.affiliation: Department of Surgery, University of Genova, Genova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Scopinaro
authors.affiliation: Department of Surgery, University of Genova, Genova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Camerini
authors.affiliation: Department of Surgery, University of Genova, Genova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Papadia
authors.affiliation: Department of Endocrinology, University of Genova, Genova, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Andraghetti
authors.affiliation: Department of Endocrinology, University of Genova, Genova, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Cordera
authors.affiliation: Department of Surgery, University of Genova, Genova, Italy. Electronic address: adami@unige.it.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Adami
mesh_terms: D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D050417:Insulin-Secreting Cells / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism / Q000601:surgery*; D011182:Postoperative Care; D011446:Prospective Studies; D015431:Weight Loss / Q000502:physiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin
keywords: Acute insulin response; Bariatric surgery; Biliopancreatic diversion; Insulinogenic index; Obesity degree; Type 2 diabetes