Long-term effects of bariatric surgery on meal disposal and β-cell function in diabetic and nondiabetic patients

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Stefania Camastra, Elza Muscelli, Amalia Gastaldelli, Jens Juul Holst, Brenno Astiarraga, Simona Baldi, Monica Nannipieri, Demetrio Ciociaro, Marco Anselmino, Andrea Mari, Ele Ferrannini

Gastric bypass surgery leads to marked improvements in glucose tolerance and insulin sensitivity in obese type 2 diabetes (T2D); the impact on glucose fluxes in response to a physiological stimulus, such as a mixed meal test (MTT), has not been determined. We administered an MTT to 12 obese T2D patients and 15 obese nondiabetic (ND) subjects before and 1 year after surgery (10 T2D and 11 ND) using the double-tracer technique and modeling of β-cell function. In both groups postsurgery, tracer-derived appearance of oral glucose was biphasic, a rapid increase followed by a sharp drop, a pattern that was mirrored by postprandial glucose levels and insulin secretion. In diabetic patients, surgery lowered fasting and postprandial glucose levels, peripheral insulin sensitivity increased in proportion to weight loss (~30%), and β-cell glucose sensitivity doubled but did not normalize (compared with 21 nonsurgical obese and lean controls). Endogenous glucose production, however, was less suppressed during the MMT as the combined result of a relative hyperglucagonemia and the rapid fall in plasma glucose and insulin levels. We conclude that in T2D, bypass surgery changes the postprandial response to a dumping-like pattern and improves glucose tolerance, β-cell function, and peripheral insulin sensitivity but worsens endogenous glucose output in response to a physiological stimulus.

Original languageEnglish
JournalDiabetes
Volume62
Issue number11
Pages (from-to)3709-17
Number of pages9
ISSN0901-3652
DOIs
Publication statusPublished - Nov 2013

    Research areas

  • Blood Glucose, Diabetes Mellitus, Type 2, Gastric Bypass, Glucagon, Humans, Insulin, Insulin Resistance, Insulin-Secreting Cells, Obesity, Obesity, Morbid, Weight Loss

ID: 117853799