http://www.cnr.it/ontology/cnr/individuo/prodotto/ID252586

Long-term effects of bariatric surgery on meal disposal and ss-cell function in diabetic and nondiabetic patients (Articolo in rivista)

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Long-term effects of bariatric surgery on meal disposal and ss-cell function in diabetic and nondiabetic patients (Articolo in rivista) (literal)

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Camastra, S.;Muscelli, E.;Gastaldelli, A.;Holst, J.;Astiarraga, B.;Baldi, S.;Nannipieri, M.;Ciociaro, D.;Anselmino, M.;Mari, A.;Ferrannini, E. (2013)
Long-term effects of bariatric surgery on meal disposal and ss-cell function in diabetic and nondiabetic patients
in Diabetes (N.Y.N.Y.)
(literal)

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Camastra, S.;Muscelli, E.;Gastaldelli, A.;Holst, J.;Astiarraga, B.;Baldi, S.;Nannipieri, M.;Ciociaro, D.;Anselmino, M.;Mari, A.;Ferrannini, E. (literal)

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1, 2, 5, 6, 7: Department of Internal Medicine University of Pisa, Italy; 3, 8: C.N.R. Institute of Clinical Physiology, Pisa, Italy; 4: NNF Center for Basic Metabolic Research, University of Copenhagen, Denmark; 9: Division of Bariatric Surgery, Santa Chiara Hospital, Pisa, Italy; 10: C.N.R. Institute of Biomedical Engineering, Padua, Italy; 12: Department of Internal Medicine University of Pisa, Italy/ C.N.R. Institute of Clinical Physiology, Pisa, Italy (literal)

Titolo

Long-term effects of bariatric surgery on meal disposal and ss-cell function in diabetic and nondiabetic patients (literal)

Abstract

Gastric bypass surgery leads to marked improvements in glucose tolerance and insulin sensitivity in obese type 2 diabetes; the impact on glucose fluxes in response to a physiological stimulus - such as a mixed meal (MTT) - has not been determined. We administered an MTT to 12 obese type 2 diabetic patients (T2D) and 15 obese nondiabetic subjects (ND) before and one year after surgery (10 T2D and 11 ND) using the double-tracer technique and modeling of ß-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%), ß-cell glucose sensitivity doubled but did not normalize (viz. 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 type 2 diabetes bypass surgery changes the postprandial response to a dumping-like pattern, improves glucose tolerance, ß-cell function, and peripheral insulin sensitivity but worsens endogenous glucose output in response to a physiological stimulus. (literal)

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