Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/85849
Type: Artigo de periódico
Title: Surgical Treatment Of Type 2 Diabetes In Subjects With Mild Obesity: Mechanisms Underlying Metabolic Improvements
Author: Fellici A.C.
Lambert G.
Lima M.M.O.
Pareja J.C.
Rodovalho S.
Chaim E.A.
Geloneze B.
Abstract: Background This study aims to assess the clinical and physiological effects of Roux-en-Y gastric bypass (RYGBP) on type 2 diabetes associated with mild obesity (body mass index [BMI] 30-34.9 kg/m2) over 24 months postsurgery. Methods In this prospective trial, 36 mildly obese subjects (19 males) with type 2 diabetes using oral antidiabetic drugs with (n = 24) or without insulin (n = 12) underwent RYGBP. Follow-up was conducted at baseline and 3, 6, 12, and 24 months postsurgery. The following endpoints were considered: changes in HbA1c, fasting glucose and insulin, antidiabetic therapy, BMI, oral glucose insulin sensitivity [OGIS, from meal tolerance test (MTT)], beta-cell secretory function [ΔCP(0-30)/ΔGlu(0-30) (ΔC-peptide/Δglucose ratio, MTT 0-30 min), disposition index (DI = OGIS {dot operator} ΔCP(0-30)/ΔGlu(0-30)], glucagon-like peptide (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) [incremental area under the curve (AUCi)], adiponectin, C-reactive protein, and lipids. Results All subjects achieved normal-to-overweight BMI after 3 months. Over 24 months, 31/36 (86 %) subjects presented HbA1c <7 % [complete and partial remission of diabetes in 9/36 (22 %) and 1/36 (3 %), respectively]. Since 3 months postsurgery, improvements were observed in OGIS [290 (174) to 373 (77) ml/min/m2, P = 0.009], ΔCP(0-30)/ΔGlu(0-30) [0.24 (0.19) to 0.52 (0.34) ng/mg, P = 0.001], DI [7.16 (8.53) to 19.8 (15.4) (ng/mg) (ml/min/m2), P = 0.001], GLP-1 AUCi [0.56 (0.64) to 3.97 (3.86) ng/dl {dot operator} 10 min {dot operator} 103, P = 0.000], and GIP AUCi [30.2 (12.6) to 27.0 (20.2) ng/dl {dot operator} 10 min {dot operator} 103, P = 0.004]. At baseline and after 12 months, subjects with diabetes nonremission had longer diabetes duration, higher HbA1c, lower beta-cell secretory function, and higher first 30-min GIP AUCi, compared with those with remission. Conclusions RYGBP improves the glucose metabolism in subjects with type 2 diabetes and mild obesity. This effect is associated with improvement of insulin sensitivity, beta-cell secretory function, and incretin secretion. © 2014 Springer Science+Business Media New York.
Editor: 
Rights: fechado
Identifier DOI: 10.1007/s11695-014-1377-9
Address: http://www.scopus.com/inward/record.url?eid=2-s2.0-84905310798&partnerID=40&md5=403b56bc2647880c5eca4d3aeea8c9cb
Date Issue: 2014
Appears in Collections:Unicamp - Artigos e Outros Documentos

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