title: Long-Term Outcomes of Biliopancreatic Diversion on Glycemic Control, Insulin Sensitivity and Beta Cell Function.
abstract: We aimed to assess the long-term outcomes of biliopancreatic diversion (BPD) surgery on glycemic control, insulin sensitivity (IS), and beta cell function using complementary oral and intravenous dynamic tests.
  
  
  
  A total of 57 women were divided into three groups: 19 lean, 18 obese (both groups with normal glucose tolerance (NGT)), and 20 obese with type 2 diabetes who underwent BPD and were reassessed 12 months after the procedure. OGTTs and hyperglycemic clamps (HG) were performed. Mathematical modeling was used to analyze IS, beta cell function, and delayed time of beta cell response. The basal, dynamic (first phase/steps of insulin secretion), and static (second phase/steps of insulin secretion) disposition indexes were calculated.
  
  
  
  After surgery, the patients exhibited improvements in glycemic control and 15 patients achieved diabetes remission. The surgical patients demonstrated normalized IS in OGGT and HG tests compared to the control groups. The basal beta cell function was improved but remained impaired compared to the Lean NGT group. The stimulated beta cell function parameters showed marked improvements regarding the intravenous stimulus and the second phase/distal steps of insulin secretion. The delay time markedly decreased and became normalized in both dynamic tests.
  
  
  
  The common physiopathology features of type 2 diabetes, i.e., impaired IS and beta cell dysfunction, were demonstrated to be primarily functional and were likely to be reversible to some degree after the BPD. The marked long-term improvement in glycemic control after BPD was closely related to IS improvement and mainly by the recovery of several beta cell physiological features.
authors.affiliation: Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas, Campinas, SP, Brazil. ana.vasques@fca.unicamp.br.|School of Applied Sciences, University of Campinas, Limeira, Brazil. ana.vasques@fca.unicamp.br.
authors.forename: Ana Carolina Junqueira
authors.initials: AC
authors.lastname: Vasques
authors.affiliation: Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas, Campinas, SP, Brazil.|Department of Surgery, University of Campinas, Campinas, Brazil.
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Pareja
authors.affiliation: Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas, Campinas, SP, Brazil.
authors.forename: Maria
authors.initials: M
authors.lastname: da Saúde de Oliveira
authors.affiliation: Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas, Campinas, SP, Brazil.
authors.forename: Fernanda Satake
authors.initials: FS
authors.lastname: Novaes
authors.affiliation: Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas, Campinas, SP, Brazil.
authors.forename: Marcelo Miranda Oliveira
authors.initials: MM
authors.lastname: Lima
authors.affiliation: Department of Surgery, University of Campinas, Campinas, Brazil.
authors.forename: Élinton A
authors.initials: ÉA
authors.lastname: Chaim
authors.affiliation: Department of Information Engineering, University of Padova, Padova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Piccinini
authors.affiliation: Department of Information Engineering, University of Padova, Padova, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Dalla Man
authors.affiliation: Department of Information Engineering, University of Padova, Padova, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cobelli
authors.affiliation: Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas, Campinas, SP, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Geloneze
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000601:surgery*; D005260:Female; D005947:Glucose / Q000378:metabolism; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology*; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism / Q000601:surgery*
chemical_list: D001786:Blood Glucose; D007328:Insulin; D005947:Glucose
keywords: Beta cell function; Biliopancreatic diversion; Hyperglycemic clamp; Insulin resistance; Insulin secretion; Obesity; Remission; Type 2 diabetes