Restoration of high-frequency glucose-entrained insulin oscillations in obese subjects with type 2 diabetes after biliopancreatic diversion

• Published in: Surgery for obesity and related diseases Vol. 12; no. 8; pp. 1539 - 1547
• Main Authors: Leonardou, Angeliki S., M.D, Karystianos, Christopher, Ph.D, Argyropoulos, Christos, M.D, Nikiforidis, George C., M.D, Kalfarentzos, Fotis, M.D, Alexandrides, Theodore K., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2016
• Subjects: Adult; Bariatric surgery; Biliopancreatic Diversion; Blood Glucose - metabolism; Body Mass Index; Case-Control Studies; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - surgery; Fasting - blood; Female; Gastroenterology and Hepatology; Glucose - administration & dosage; Glucose - pharmacology; Glucose entrainment; Glucose Tolerance Test; Humans; Infusions, Intravenous; Insulin - metabolism; Insulin oscillations; Insulin Resistance - physiology; Insulin-Secreting Cells - physiology; Male; Obesity, Morbid - blood; Obesity, Morbid - surgery; Postoperative Care; Prospective Studies; Surgery; Sweetening Agents - administration & dosage; Sweetening Agents - pharmacology; Type 2 diabetes; Weight Loss - physiology; Type 2 diabetes; Insulin oscillations; Glucose entrainment; Bariatric surgery
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2016.04.009

Abstract Background Minimal glucose infusions are known to entrain insulin oscillations in patients with normal glucose tolerance (NGT) but not in patients with type 2 diabetes (T2D). Objectives To investigate whether weight loss after a version of biliopancreatic diversion (BPD) can restore the glucose entrainment of high-frequency insulin oscillations in morbidly obese NGT or T2D patients. Setting University Hospital, Greece. Methods We prospectively studied 9 NGT controls (body mass index [BMI] 23.3±1.6 kg/m2 ), 9 obese NGT patients (BMI 51.1±12.7 kg/m2 ), and 9 obese T2D patients (BMI 56.8±11.6 kg/m2 ). Patients were studied before and 1.5 years after BPD. Insulin was sampled every minute for 90 minutes. Glucose (6 mg/kg weight) was infused every 10 minutes for 1 minute. Regularity of insulin pulses was estimated by autocorrelation analysis, spectral analysis, approximate entropy/sample entropy (ApEn/SampEn), and insulin pulsatility by deconvolution analysis. Results Postoperatively, glucose and insulin concentrations of NGT and T2D patients decreased to control levels and BMI to 31.3±6.3 for NGT patients and 34.9±9.9 kg/m2 for T2D patients. Preoperatively, glucose entrainment was absent in all T2D and in 4 NGT patients as assessed with spectral analysis and in 8 and 4, respectively, as assessed with autocorrelation and deconvolution analysis. Postoperatively, it was restored to normal in all patients. ApEn/SampEn decreased significantly only in the T2D group postoperatively. Conclusion BPD restores the glucose entrainment of high-frequency insulin oscillations in obese NGT and T2D patients after marked weight loss and normalizes glucose levels and insulin sensitivity, thus demonstrating recovery of β-cell glucose sensing.