PMID- 21778221
OWN - NLM
STAT- MEDLINE
DCOM- 20111123
LR  - 20220309
IS  - 1945-7197 (Electronic)
IS  - 0021-972X (Linking)
VI  - 96
IP  - 9
DP  - 2011 Sep
TI  - The role of beta-cell function and insulin sensitivity in the remission of type 2 
      diabetes after gastric bypass surgery.
PG  - E1372-9
LID - 10.1210/jc.2011-0446 [doi]
AB  - CONTEXT: Bariatric surgery can induce remission in a high proportion of severely 
      obese patients with type 2 diabetes mellitus (T2DM). OBJECTIVE: Our objective was 
      to investigate predictors and mechanisms of surgery-induced diabetes remission. 
      PATIENTS AND SETTING: Forty-three morbidly obese subjects (body mass index = 45.6 
      +/- 5.0 kg/m(2)), 32 with T2DM and 11 nondiabetic [normal glucose tolerance (NGT)], 
      participated at a clinical research center. INTERVENTION: Patients underwent 
      Roux-en-Y gastric bypass. MAIN OUTCOME MEASURES: Diabetes remission and beta-cell 
      function were evaluated. RESULTS: Subjects were tested before and 45 d and 1 yr 
      after surgery. Weight decreased similarly in T2DM and NGT (-39 kg at 1 yr, P < 
      0.0001). Insulin sensitivity improved in both groups in proportion to the changes 
      in body mass index but remained lower in T2DM than NGT (386 +/- 91 vs. 479 +/- 89 
      ml/min . m(2), P < 0.01). Based on glycosylated hemoglobin and oral glucose 
      testing, diabetes had remitted in nine patients at 45 d and in an additional 16 
      at 1 yr. In T2DM, beta-cell glucose sensitivity increased early after surgery but 
      was no further improved and still abnormal at 1 yr [median, 48 (coefficient 
      interval, 53) pmol/min . m(2) . mm vs. median, 100 (coefficient interval, 68) of 
      NGT, P < 0.001]. Baseline beta-cell glucose sensitivity was progressively worse in 
      early remitters, late remitters, and nonremitters (median, 54[coefficient 
      interval, 50] vs. median, 22[coefficient interval, 26] vs. median, 4[coefficient 
      interval, 10] pmol/min . m(2) . mm) and, by logistic regression, was the only 
      predictor of failure [odds ratio for bottom tertile = 7.9 (95% confidence 
      interval = 1.2-51.9); P = 0.03]. CONCLUSIONS: In morbid obesity, Roux-en-Y 
      gastric bypass causes rapid and profound metabolic adaptations; insulin 
      sensitivity improves in proportion to the weight loss, and beta-cell glucose 
      sensitivity increases independently of weight loss. Over a period of 1 yr after 
      surgery, diabetes remission depends on the starting degree of beta-cell dysfunction.
FAU - Nannipieri, M
AU  - Nannipieri M
AD  - Department of Internal Medicine, University of Pisa, Via Roma 67, 56100 Pisa, 
      Italy. nannipi@ifc.cnr.it
FAU - Mari, A
AU  - Mari A
FAU - Anselmino, M
AU  - Anselmino M
FAU - Baldi, S
AU  - Baldi S
FAU - Barsotti, E
AU  - Barsotti E
FAU - Guarino, D
AU  - Guarino D
FAU - Camastra, S
AU  - Camastra S
FAU - Bellini, R
AU  - Bellini R
FAU - Berta, R D
AU  - Berta RD
FAU - Ferrannini, E
AU  - Ferrannini E
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110721
PL  - United States
TA  - J Clin Endocrinol Metab
JT  - The Journal of clinical endocrinology and metabolism
JID - 0375362
RN  - 0 (Blood Glucose)
RN  - 0 (Insulin)
SB  - IM
MH  - Adult
MH  - Blood Glucose/metabolism
MH  - Diabetes Mellitus, Type 2/*metabolism/physiopathology/surgery
MH  - Female
MH  - Gastric Bypass
MH  - Humans
MH  - Insulin/*metabolism
MH  - Insulin Resistance/*physiology
MH  - Insulin-Secreting Cells/*metabolism
MH  - Male
MH  - Middle Aged
MH  - Obesity, Morbid/*metabolism/physiopathology/surgery
MH  - Remission Induction
MH  - Weight Loss/physiology
EDAT- 2011/07/23 06:00
MHDA- 2011/12/13 00:00
CRDT- 2011/07/23 06:00
PHST- 2011/07/23 06:00 [entrez]
PHST- 2011/07/23 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
AID - jc.2011-0446 [pii]
AID - 10.1210/jc.2011-0446 [doi]
PST - ppublish
SO  - J Clin Endocrinol Metab. 2011 Sep;96(9):E1372-9. doi: 10.1210/jc.2011-0446. Epub 
      2011 Jul 21.