Normalization of Insulin Sensitivity in the Obese Patient after Stable Weight Reduction with Bilio-Pancreatic Diversion |
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| Authors: | Marco Castagneto MD FACS Andrea De Gaetano MD MS Geltrude Mingrone MD Roberto Tacchino MD Giuseppe Nanni MD Esmeralda Capristo MD Giuseppe Benedetti MD Pietro Antonio Tataranni MD Aldo Virgilio Greco MD |
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| Institution: | (1) Divisione di chirurgia sostitutiva e dei trapianti d'organi, Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore and CNR - Centro Fisiopatologia Shock, Rome, Italy;(2) Divisione di chirurgia sostitutiva e dei trapianti d'organi, Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore and CNR - Centro Fisiopatologia Shock, Rome, Italy;(3) Divisione Malattie Metaboliche, Università Cattolica del Sacro Cuore, Rome, Italy;(4) Divisione di chirurgia sostitutiva e dei trapianti d'organi, Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore and CNR - Centro Fisiopatologia Shock, Rome, Italy;(5) Divisione di chirurgia sostitutiva e dei trapianti d'organi, Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore and CNR - Centro Fisiopatologia Shock, Rome, Italy;(6) Divisione Malattie Metaboliche, Università Cattolica del Sacro Cuore, Rome, Italy;(7) Divisione Malattie Metaboliche, Università Cattolica del Sacro Cuore, Rome, Italy;(8) Divisione Malattie Metaboliche, Università Cattolica del Sacro Cuore, Rome, Italy;(9) Divisione Malattie Metaboliche, Università Cattolica del Sacro Cuore, Rome, Italy |
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| Abstract: | Insulin resistance is a common feature in obese patients. To evaluate the modifications in insulin sensitivity after a bariatric
operation such as Bilio-pancreatic diversion (BPD), three groups of subjects (14 normal controls (N); seven eX-obese patients
(X) with at least 2 years at weight-stable conditions after BPD surgery; and eight morbidly obese patients (O)) were studied
with intravenous (IVGTT) and oral (OGTT) glucose tolerance tests. The ratio of the area under the curve (AUC) for glucose
over that of insulin was used as a measure of insulin sensitivity. All the following tests were conducted as Bonferroni-corrected
pairwise t-tests, in case overall ANOVA was significant. No significant difference was found between N and X subjects, while obese patients
showed a reduced AUCg/AUCi ratio with respect to the normal controls (O vs N: 0.01164 ± 0.00039 vs 0.02392 ± 0.0039, p < 0.05). IVGTT, AUCs: significant differences were found in each case: N vs X: 0.0591 ± 0.0075 vs 0.1402 ± 0.0399, p < 0.05; N vs O: 0.0591 ± 0.0075 vs 0.0223 ± 0.0031, p < 0.01; X vs O: 0.1402 ± 0.0399 vs 0.0223 ± 0.0031, p < 0.05. IVGTT-derived data were also analyzed using the minimal model of glucose kinetics; with this method, glucose effectiveness
was significantly different between normal subject and obese subjects (0.0248 ± 0.00288 vs 0.00905 ± 0.00135 per min, p < 0.001). The insulin sensitivity index was not significantly different between normal and ex-obese subjects, while both
of these groups were significantly different from obese patients (N vs O: 12.04 × 10−5 ± 2.61 × 10−5 vs 3.29 × 10−5 ± 0.61 × 10−5, p < 0.066; X vs O: 16.42 × 10−5 ± 4.23 × 10−5 vs 3.29 × 10−5 ± 0.61 × 10−5 per min per pM, p < 0.02). In conclusion, the present study indicates that, after a body weight reduction operation capable of almost re-establishing
ideal body weight like BPD, obese individuals with a family history of obesity show a normalization of insulin response to
glucose load. |
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| Keywords: | Obesity bilio-pancreatic diversion glucose kinetics glucose metabolism mathematics models insulin sensitivity |
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