title: [Incretin secretion and glucose metabolism in morbidly obese patients in the early and late periods after biliopancreatic diversion].
abstract: OBJECTIVE
  To estimate the parameters of glucose metabolism and to assess the secretion of incretins in patients after biliopancreatic diversion (BPD) for morbid obesity (MO) in the early and late postoperative periods.
  
  
  METHODS
  The prospective part of the investigation included 22 patients with a body mass index of 35.8 to 68.4 kg/m2 and type 2 diabetes mellitus (T2DM). All the patients were examined before, 3 weeks and 3 months after BPD. The retrospective part covered 23 patients who were examined after BPD for MO; the postoperative period was 4.7 [2.3; 7.2] years. A control group consisted of 22 healthy, normal weight volunteers. A 75-g oral glucose tolerance test was carried out in all the groups to study the levels of glucose, immunoreactive insulin (IRI), glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP) and glucagon at 0, 30, 60, and 120 min.
  
  
  RESULTS
  T2DM patients showed improvement in glucose metabolism just 3 weeks after BPD; following 3 months, they had normalized fasting blood glucose levels (5.6 [5.0; 6.0] mmol/l). During 3 months, glycated hemoglobin decreased from 7.5 [6.6; 8.5] to 5.7 [5.3; 5.9]%. In the early period following BPD, there was an increase in basal and postprandial GLP-1 levels associated with the peak IRI concentration. In the late period after BPD, the enhanced secretion of IRI and GLP-1 persisted, which was followed by a reduction in postprandial glucose levels in 4 of the 23 patients.
  
  
  CONCLUSIONS
  T2DM remission does not depend on weight loss in the early period after BPD. In this period, the significant improvement of glucose metabolic parameters in patients with obesity and T2DM is associated with elevated GLP-1 levels. The altered incretin response is a stable effect of BPD and remains in its late period.
authors: Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia; M.V. Lomonosov Moscow State University, Moscow, Russia.
authors: I I
authors: II
authors: Dedov
authors: Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors: G A
authors: GA
authors: Melnichenko
authors: Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors: E A
authors: EA
authors: Troshina
authors: Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors: E V
authors: EV
authors: Ershova
authors: Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors: N V
authors: NV
authors: Mazurina
authors: Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors: N A
authors: NA
authors: Ogneva
authors: Center for Endosurgery and Lithotripsy, Moscow, Russia.
authors: Yu I
authors: YI
authors: Yashkov
authors: Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors: А V
authors: АV
authors: Ilyin
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000628:therapy; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000032:analysis / Q000097:blood; D005947:Glucose / Q000032:analysis / Q000378:metabolism; D006801:Humans; D054795:Incretins / Q000032:analysis / Q000378:metabolism; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery; D011184:Postoperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D012426:Russia; D013223:Statistics as Topic
chemical_list: D054795:Incretins; D052216:Glucagon-Like Peptide 1; D005947:Glucose