Effects of Different Gastrointestinal Surgical Approaches on Pancreatic β-cell Function in Type 2 Diabetic Patients with BMIs<30

Abstract

Objective: Gastrointestinal surgery has been performed for many years to achieve durable and effective treatments of type 2 diabetes mellitus (T2DM). This study determined the effects of different surgical operations on pancreatic β-cell function in patients with T2DM with BMIs<30 kg/m².

Design and patients: A total of 46 patients with diabetes and BMIs<30 kg/m² underwent gastrointestinal surgery; 23 patients underwent Roux-en-Y gastric bypass (RYGB), and 23 patients underwent Billroth Ι gastrectomy (BΙG). Oral glucose tolerance tests were used to evaluate pancreatic β cell function. Serum insulin was measured by enzyme-linked immunosorbent assay (ELISA), and blood glucose was detected with the glucose oxidase method. HOMA-IR and HOMA-β were evaluated with the HOMA equation.

Results: The T2DM remission rates were 21.7% (5/23) in the BΙG group and 82.6% (19/23) in the RYGB group. There was a significant difference in the improvements in postoperative glycosylated hemoglobin A1c (GHbA1c) and glycated hemoglobin A1 (GHbA1) between the BΙG and RYGB groups (P=0.001, P=0.002). OGTT revealed that both fasting blood glucose (FBG) and blood glucose at the designated time points after glucose loading were significantly lower in the RYGB group than in the BΙG group. Insulin levels (at 30 and 60 min), insulin release indices (at 30 and 60 min), HOMA-β and ΔI30/ΔG30 were significantly higher in the RYGB group than in the BΙG group (P<0.05).

Conclusions: Patients with BMIs<30 kg/m² who underwent RYGB surgery exhibited significantly greater improvements or resolutions of T2DM and significantly better recoveries of β-cells function than did those in the BΙG group.

Key words

gastrectomy - bariatric surgery - type 2 diabetes mellitus - β-cell function

^* XU Lubai and WANG Kejia contributed equally to this work.

• References

• 1 Zimmet P, Alberti KGShaw J. Global and societal implications of the diabetes epidemic. Nature 2001; 414: 782-787
• 2 Wild S, Roglic G, Green A et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047-1053
• 3 James WP. The epidemiology of obesity: the size of the problem. J Intern Med 2008; 263: 336-352
• 4 Ballesteros-Pomar MD, Calleja S, Diez-Rodriguez R et al. Inflammatory Status is Different in Relationship to Insulin Resistance in Severely Obese People and Changes after Bariatric Surgery or Diet-induced Weight Loss. Exp Clin Endocrinol Diabetes 2014; [Epub ahead of print]
• 5 Arroyo K, Kini SU, Harvey JEHerron DM. Surgical therapy for diabesity. Mt Sinai J Med 2010; 77: 418-430
• 6 Kushner RF. Weight loss strategies for treatment of obesity. Prog Cardiovasc Dis 2014; 56: 465-472
• 7 Bachmayer C, Lammert A, Hasenberg THammes HP. Healthy obese and post bariatric patients – metabolic and vascular patterns. Exp Clin Endocrinol Diabetes 2013; 121: 483-487
• 8 Rubino F, Kaplan LM, Schauer PRCummings DE. The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg 2010; 251: 399-405
• 9 To VT, Huttl TP, Lang R et al. Changes in body weight, glucose homeostasis, lipid profiles, and metabolic syndrome after restrictive bariatric surgery. Exp Clin Endocrinol Diabetes 2012; 120: 547-552
• 10 De Paula AL, Stival AR, Halpern A et al. Improvement in insulin sensitivity and beta-cell function following ileal interposition with sleeve gastrectomy in type 2 diabetic patients: potential mechanisms. J Gastrointest Surg 2011; 15: 1344-1353
• 11 Mari A, Tura A, Pacini G et al. Relationships between insulin secretion after intravenous and oral glucose administration in subjects with glucose tolerance ranging from normal to overt diabetes. Diabet Med 2008; 25: 671-677
• 12 Stumvoll M, Mitrakou A, Pimenta W et al. Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity. Diabetes Care 2000; 23: 295-301
• 13 Dirksen C, Jorgensen NB, Bojsen-Moller KN et al. Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass. Diabetologia 2012; 55: 1890-1901
• 14 Pories WJ, Swanson MS, MacDonald KG et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995; 222: 339-350 discussion 350–352
• 15 Fried M, Ribaric G, Buchwald JN et al. Metabolic surgery for the treatment of type 2 diabetes in patients with BMI <35 kg/m²: an integrative review of early studies. Obes Surg 2010; 20: 776-790
• 16 Thaler JP, Cummings DE. Minireview: Hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocrinology 2009; 150: 2518-2525
• 17 Mingrone G, Castagneto-Gissey L. Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery. Diabetes Metab 2009; 35: 518-523
• 18 Rubino F, Forgione A, Cummings DE et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 2006; 244: 741-749
• 19 Patriti A, Facchiano E, Sanna A et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery. Obes Surg 2004; 14: 840-848
• 20 Saeidi N, Meoli L, Nestoridi E et al. Reprogramming of intestinal glucose metabolism and glycemic control in rats after gastric bypass. Science 2013; 341: 406-410
• 21 Service GJ, Thompson GB, Service FJ et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med 2005; 353: 249-254