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Surgical Endoscopy

Published in:

01-08-2009

Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20–34

Authors: Aureo Ludovico DePaula, A. L. V. Macedo, V. Schraibman, B. R. Mota, S. Vencio

Published in: Surgical Endoscopy | Issue 8/2009

Abstract

Background

A group of patients with type 2 diabetes mellitus (T2DM) and body mass index (BMI) 20–34 kg/m² were submitted to laparoscopic interposition of a segment of ileum into the proximal jejunum or into the proximal duodenum associated to a sleeve gastrectomy. The objective of this study is to evaluate the hormonal changes in the pre- and postoperative period.

Materials and methods

Hormonal evaluation was done in 58 patients operated between April 2005 and July 2006. Mean age was 51.4 years (40–66 years). Mean BMI was 28.2 (20–34.8) kg/m². All patients had had the diagnosis of T2DM for at least 3 years. Mean duration of T2DM was 9.6 years (3–22 years). Two techniques were performed, consisting of different combinations of ileal interposition (II) associated to a sleeve gastrectomy (SG). The following hormones were assayed in the pre- and postoperative period (mean 16 months) at the baseline and following specific food stimulation (30, 60, 120 min): glucogen-like protein 1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), insulin, glucagon, C-peptide, amylin, colecystokinin (CCK), pancreatic polypeptide (PPP), somatostatin, peptide YY (PYY), ghrelin, adiponectin, resistin, leptin, and interleukin-6 (IL-6).

Results

Thirty patients had II associated to sleeve gastrectomy (II-SG) and 28 had II with diverted sleeve gastrectomy (II-DSG). GLP1 exhibited an important rise following the two operations, especially after II-DSG (p < 0.001). GIP also exhibited an important rise, with both II-SG and II-DSG being equally effective (p < 0.001). Insulin and amylin showed a significant rise at 30 min. Glucagon decreased slightly. CCK measurements were very low after II-DSG. PPP was also slightly altered by the II-DSG. PYY showed an important increase with both operations (p < 0.001). Ghrelin showed a significant decrease following the two operations (p < 0.001).Somatostatin and IL-6 were not affected (p = 0.632). Both leptin and resistin blood levels decreased. Adiponectin showed a slight increase. Mean postoperative follow-up was 19.2 months. Both II-SG and II-DSG were effective in achieving adequate glycemic control (91.2%).

Conclusions

There was a significant hormonal change following laparoscopic ileal interposition. These alterations may explain the promising good results associated to these operations for the treatment of T2DM in the nonmorbidly obese population.

Creutzfeldt W (1979) The incretin concept today. Diabetologia 16:75–85PubMedCrossRef

Gautier JF, Fetita S, Sobngwi E, Salaun-Martin C (2005) Biological actions of the incretins GIP and GLP-1 and therapeutic perspectives in patients with type 2 diabetes. Diabetes Metab 31:233–242PubMedCrossRef

Vilsboll T, Krarup T, Madsbad S, Holst JJ (2002) Defective amplification of the late phase insulin response to glucose by GIP in obese type II diabetic patients. Diabetologia 45:1111–1119PubMedCrossRef

Knopp FI, Vilsboll T, Hojberg PV, Lasrsen S, Madsbad S, Holst JJ, Krarup T (2007) The insulinotropic effect of GIP is impaired in patients with chronic pancreatitis and secondary diabetes mellitus as compared to patients with chronic pancreatitis and normal glucose tolerance. Regul Pept 144:123–130CrossRef

Heijboer AC, Pijil H, Van den Hoek AM, Havekes LM, Romijn JA, Corssmit EPM (2006) Gut–brain axis: regulation of glucose metabolism. J Neuroendocrinol 18:883–894PubMedCrossRef

DePaula AL, Macedo ALV, Rassi N, Machado CA, Schraibman V, Silva LQ, Halpern H (2008) Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35. Surg Endosc 22:706–716PubMedCrossRef

Kahn SE (2001) Beta-cell failure: causes and consequences. Int J Clin Pract 123:13–18

Luzi L, DeFronzo RA (1989) Effect of loss of first-phase insulin secretion on hepatic glucose production and tissue glucose disposal in humans. Am J Physiol 257:E241–E246PubMed

Rask E, Olsson T, Soderberg S, Holst JJ, Tura A, Pacini G, Ahren B (2004) Insulin secretion and incretin hormones after oral glucose in nonobese subjects with impaired glucose tolerance. Metabolism 53:624–631PubMedCrossRef

10.

Eissele R, Göke R, Willemer S, Harthus HP, Vermeer H, Arnold R, Göke B (1992) Glucagon-like peptide-1 cells in the gastrointestinal tract and pancreas of rat, pig and man. Eur J Clin Invest 22:283–291PubMedCrossRef

11.

Ahrén B, Host JJ, Mari A (2003) Characterization of GLP-1 effects on β-cell function after meal ingestion in humans. Diabetes Care 26:2860–2864PubMedCrossRef

12.

Vilsboll T, Knop FK, Krarup T, Johansen A, Madsbad S, Larsen S, Hansen T, Pedersen O, Holst JJ (2003) The pathophysiology of diabetes involves a defective amplification of the late-phase insulin response to glucose by glucose-dependent insulinotropic polypeptide regardless of etiology and phenotype. J Clin Endocrinol Metab 88:4897–4903PubMedCrossRef

13.

Theodorakis MJ, Carlson O, Muller DC, Egan JM (2004) Elevated plasma glucose-dependent insulinotropic polypeptide associates with hyperinsulinemia in impaired glucose tolerance. Diabetes Care 27:1692–1698PubMedCrossRef

14.

Zhou H, Yamada Y, Tsukiyama K, Miyawaki K, Hosokawa M, Nagashima K, Toyoda K, Naitoh R, Mizunoya W, Fushiki T, Kadowaki T, Seino Y (2005) Gastric inhibitory polypeptide modulates adiposity and fat oxidation under diminished insulin action. Biochem Biophys Res Commun 335:937–942PubMedCrossRef

15.

Yach D, Stuckler D, Brownell KD (2006) Epidemiologic and economic consequences of the global epidemics of obesity and diabetes. Nat Med 12:62–66PubMedCrossRef

16.

Swinburn B (1993) Effects of dietary lipid on insulin action. Ann NY Acad Sci 683:102–109PubMedCrossRef

17.

Gauna C, Meyler FM, Janssen JA, Delhanty PJ, Abribat T, van Koetsveld P, Hofland LJ, Broglio F, Ghigo E, van der Lely AJ (2004) Administration of acylated ghrelin reduces insulin sensitivity, whereas the combination of acylated plus unacylated ghrelin strongly improves insulin sensitivity. J Clin Endocrinol Metab 89:5035–5042PubMedCrossRef

18.

Lippl F, Kircher F, Erdmann J, Allescher HD, Schusdziarra V (2004) Effect of GIP, GLP-1, insulin and gastrin on ghrelin release in the isolated rat stomach. Regul Pept 119:93–98PubMedCrossRef

19.

Dezaki K, Hosoda H, Kakei M, Hashiguchi S, Watanabe M, Kangawa K, Yada T (2004) Endogenous ghrelin in pancreatic islets restricts insulin release by attenuating Ca² signaling in β-cells. Diabetes 53:3142–3151PubMedCrossRef

20.

Kjems LL, Holst JJ, Volund A, Madsbad S (2003) The influence of GLP-1 on glucose-stimulated insulin secretion: effects on beta-cell sensitivity in type 2 and nondiabetic subjects. Diabetes 52:380–386PubMedCrossRef

21.

Drucker DJ (2003) Enhancing incretin action for the treatment of type 2 diabetes. Diabetes Care 26:2929–2940PubMedCrossRef

22.

Irwin N, Gault VA, Green BD, Greer B, McCluskey JT, Harriott P, O’Harte FP, Flatt PR (2004) Effects of short-term chemical ablation of GIP receptor on insulin secretion, islet morphology and glucose homeostasis in mice. Biol Chem 385:845–852PubMedCrossRef

23.

Gault VA, Irwin N, Green BD, Mccluskey JT, Greer B, Bailey CJ, Harriott P, O’Harte FPM, Flatt PR (2005) Chemical ablation of gastric inhibitory polypeptide receptor action by daily (Pro 3) GIP administration improves glucose tolerance and ameliorates insulin resistance and abnormalities of islet structure in obesity-related diabetes. Diabetes 54:2436–2446PubMedCrossRef

24.

Ferrannnini E, Cobeli C (1987) The kinetics of insulin in man. I. General aspects. Diab Metab Rev 3:335–363CrossRef

25.

Ferrannini E (1998) Insulin resistance versus insulin deficiency in non-insulin dependent diabetes mellitus: problems and prospects. Endocr Rev 19:477–490PubMedCrossRef

26.

Ferrannini E, Mari A (2004) Beta cell function and its relation to insulin action in humans: a critical appraisal. Diabetologia 47:943–956PubMedCrossRef

27.

Kahn SE (2001) The importance of β-cell failure in the development and progression of type 2 diabetes. J Clin Endocrinol Metab 86:4047–4058PubMedCrossRef

28.

Gromada J, Franklin I, Wollheim CB (2007) α-Cells of the endocrine pancreas: 35 years of research but the enigma remains. Endocr Rev 28:84–116PubMedCrossRef

29.

Dunning BE, Foley JE, Ahren B (2005) α-Cell function in health and disease: influence of glucagon-like peptide-1. Diabetologia 48:1700–1713PubMedCrossRef

30.

Shah P, Vella A, Basu A, Basu R, Schwenk WF, Rizza R (2000) Lack of suppression of glucagon contributes to postprandial hyperglycemia in subjects with type 2 diabetes mellitus. J Clin Endocrinol Metab 85:4053–4059PubMedCrossRef

31.

Esler PW, Rudolph J, Claus TH, Tang W, Barucc N, Brown SU, Bullock W, Daly M, DeCarr L, Li Y, Milardo L, Molstad D, Zhu J, Gardell SJ, Livingston JN, Sweet L (2007) Small-molecule ghrelin receptor antagonists improve glucose tolerance, suppress appetite, and promote weight loss. Endocrinology 148:5175–5185PubMedCrossRef

32.

Le Roux CW, Batterham RL, Aylwin SJ, Patterson M, Borg CM, Wynne KJ, Kent A, Vincent RP, Gardiner J, Ghatei MA, Bloom SR (2006) Attenuated peptide YY release in obese subjects is associated with reduced satiety. Endocrinology 147:3–8PubMedCrossRef

33.

Borg CM, Le Roux CW, Ghatei MA, Bloom SR, Patel AG, Aylwin SJB (2006) Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety. Br J Surg 93:210–215PubMedCrossRef

34.

Hoppener JWM, Ahren B, Lips CJM (2000) Islet amyloid and type 2 diabetes mellitus. N Engl J Med 343:411–419PubMedCrossRef

35.

Philips LK, Horowitz M (2006) Amylin. Curr Opin Endocrinol Diabetes 13:191–198CrossRef

36.

Asakawa A, Inui A, Yuzuriha H, Ueno N, Katsuura G, Fujimiya M, Fujino MA, Niijima A, Meguid MM, Kasuga M (2003) Characterization of the effects of pancreatic polypeptide in the regulation of energy balance. Gastroenterology 124:1325–1336PubMedCrossRef

37.

Kojima S, Ueno N, Asakawa A, Sagiyama K, Naruo T, Mizuno S, Inui A (2007) A role for pancreatic polypeptide in feeding and body weight regulation. Peptides 28:459–463PubMedCrossRef

38.

Yamomoto Y, Hirose H, Saito I, Tomita M, Taniyama M, Matsubara K, Okazaki Y, Ishii T, Nishikai K, Saruta T (2002) Correlation of the adipocyte-derived protein adiponectin with insulin resistance index and serum high-density lipoprotein-cholesterol, independent of body mass index, in the Japanese population. Clin Sci (Lond) 103:137–142

39.

Weyer C, Funahashi T, Tanaka S, Hotta K, Matsuzawa Y, Pratley RE, Tataranni PA (2001) Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia. J Clin Endeocrinol Metab 85:1930–1935CrossRef

40.

Shetty GK, Economides ES, Horton ES, Mantzoros CS, Veves A (2004) Circulating adiponectin and resistin levels in relation to metabolic factors, inflammatory markers, and vascular reactivity in diabetic patients and subjects at risk for diabetes. Diabetes Care 27:2450–2457PubMedCrossRef

41.

DePaula, AL, Macedo AL, Rassi N, Vencio S, Machado CA, Mota BR, Silva LQ, Halpern A, Schraibman V (2008) Laparoscopic treatment of metabolic syndrome in patients with type 2 diabetes mellitus. Surg Endosc [Epub ahead of print]

42.

Anini Y, Brubaker PL (2003) Role of leptin in the regulation of glucagon-like peptide-1 secretion. Diabetes 52:252–259PubMedCrossRef

43.

Kieffer TJ, Habener JF (2000) The adipoinsular axis: effects of leptin on pancreatic β-cells. Am J Physiol Endocrinol Metab 278:E1–E14PubMed

44.

Steppan CM, Bailey ST, Bhat S, Brown EJ, Banerjee RR, Wright CM, Patel HR, Ahima RS, Lazar MA (2001) The hormone resistin links obesity to diabetes. Nature 409:307–312PubMedCrossRef

45.

Rajala MW, Qi Y, Patel HR, Takahashi N, Banerjee R, Pajvani UB, Sinha MK, Gingerich RL, Scherer PE, Ahina RS (2004) Regulation of resistin expression and circulating levels in obesity, diabetes, and fasting. Diabetes 53:1671–1679PubMedCrossRef

46.

Hansotia T, Drucker DJ (2005) GIP and GLP-1 as incretin hormones: lessons from single and double incretin receptor knockout mice. Regul Pept 128:125–134PubMedCrossRef

Title: Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20–34
Authors: Aureo Ludovico DePaula
A. L. V. Macedo
V. Schraibman
B. R. Mota
S. Vencio
Publication date: 01-08-2009
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 8/2009
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-008-0168-6

At a glance: The STEP trials

Springer Medicine

Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20–34

Abstract

Background

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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