Biliopancreatic diversion in nonobese patients with type 2 diabetes: impact and mechanisms (Articolo in rivista)

Type
Label
  • Biliopancreatic diversion in nonobese patients with type 2 diabetes: impact and mechanisms (Articolo in rivista) (literal)
Anno
  • 2013-01-01T00:00:00+01:00 (literal)
Http://www.cnr.it/ontology/cnr/pubblicazioni.owl#doi
  • 10.1210/jc.2013-1476 (literal)
Alternative label
  • Astiarraga, B.;Gastaldelli, A.;Muscelli, E.;Baldi, S.;Camastra, S.;Mari, A.;Papadia, F.;Camerini, G.;Adami, G.;Scopinaro, F.;Ferrannini, E. (2013)
    Biliopancreatic diversion in nonobese patients with type 2 diabetes: impact and mechanisms
    in The Journal of clinical endocrinology and metabolism
    (literal)
Http://www.cnr.it/ontology/cnr/pubblicazioni.owl#autori
  • Astiarraga, B.;Gastaldelli, A.;Muscelli, E.;Baldi, S.;Camastra, S.;Mari, A.;Papadia, F.;Camerini, G.;Adami, G.;Scopinaro, F.;Ferrannini, E. (literal)
Pagina inizio
  • 2765 (literal)
Pagina fine
  • 2773 (literal)
Http://www.cnr.it/ontology/cnr/pubblicazioni.owl#url
  • http://www.ncbi.nlm.nih.gov/pubmed/23666972 (literal)
Http://www.cnr.it/ontology/cnr/pubblicazioni.owl#numeroVolume
  • 98 (literal)
Rivista
Http://www.cnr.it/ontology/cnr/pubblicazioni.owl#numeroFascicolo
  • 7 (literal)
Note
  • ISI Web of Science (WOS) (literal)
  • Scopu (literal)
Http://www.cnr.it/ontology/cnr/pubblicazioni.owl#affiliazioni
  • 1, 3, 4, 5, 11: Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, 56100 Pisa, Italy; 2: CNR Institute of Clinical Physiology, 56124 Pisa, Italy; 6: Italy; Institute of Biomedical Engineering, 35127 Padova, Italy; 7-10: Department of Surgery University of Genova, 16147 Genova, Italy (literal)
Titolo
  • Biliopancreatic diversion in nonobese patients with type 2 diabetes: impact and mechanisms (literal)
Abstract
  • Context: Diabetes remission is frequent after biliopancreatic diversion (BPD) in morbidly obese patients with type 2 diabetes (T2D). Data, mechanisms, and clinical indications in nonobese T2D patients are scanty. Objective: The objective of the study was to assess remission and investigate insulin sensitivity and ?-cell function after BPD in nonobese patients with long-standing T2D. Design, Setting, and Patients: This was a clinical research study comparing 15 T2D patients (aged 55 ? 1 years, duration of 16 ? 2 years, body mass index of 28.3 ? 0.6 kg/m2, glycosylated hemoglobin 8.6% ? 1.3%) with 15 gender-, age-, and body mass index-matched nondiabetic controls. Before surgery and 2 months and 1 year later, a 3-hour oral glucose tolerance test, a 5-hour mixed-meal test, and a 3-hour euglycemic clamp were performed. Intervention: The intervention included a BPD (distal gastrectomy, proximal ileum anastomosed to remaining stomach, biliopancreatic limb anastomosed to ileum 50 cm from the ileocecal valve). Results: Glycemia improved in all patients, but remission (glycosylated hemoglobin ? 6.5% and normal oral glucose tolerance test) occurred in 6 of 15 patients. Insulin resistance (19.8 ? 0.8 ?mol ? min?1 ? kgffm ?1, P ? .001 vs 40.9 ? 5.3 of controls) resolved already at 2 months (34.2 ? 2.8) and was sustained at 1 year (34.7 ? 1.6), although insulin-mediated suppression of endogenous glucose production remained impaired. In contrast, ?-cell glucose sensitivity (19 [12] pmol?min?1 ? m?2?mM?1 vs 96 [73] of controls, P ? .0001) rose (P ? .02) only to 31 [26] at 1 year and was lower in nonremitters (16 [18]) than remitters (46 [33]). Conclusions: In nonobese patients with long-standing T2D, BPD improves metabolic control but induces remission in only approximately 40% of patients. Peripheral insulin sensitivity is restored early after surgery and similarly in remitters and nonremitters, indicating a weight-independent effect of the operation. The initial extent of ?-cell incompetence is the main predictor of the metabolic outcome (literal)
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