Objective of the study: Purpose of this study was to evaluate the effect of SG on insulin secretion and sensitivity immediately after surgery before any weight change and any passage of food through the gastrointestinal (G.I.) tract.
Methods and procedures: Two groups of morbidly obese patients were studied: group A (9 diabetic patients (DM), 3 women and 6 men, with less than 10 years of disease; age 48.43 ± 7.48 years, BMI 44.75 ± 7.83 kg/m2, HbA1c 6.64 ± 0.74 % ) and group B (6 non-diabetic obese patients, 5 women and 1 man; age 45.3 ± 10 years, BMI 48.3 ± 6.8 kg/m2).
Insulin secretion and peripheral insulin sensitivity using Intravenous Glucose Tolerance Test (IVGTT) were assessed in all patients before and 3 days after SG before any passage of food through the G.I. tract and any weight change. After a 3 days fast and on the third p.o. day (non caloric lipids a.l.) an intravenous bolus of 12 gr of glucose/ m2 body surface as 50% water solution was injected. In the contralateral antecubital vein, blood samples were obtained at different minutes after glucose injection in order to assess insulin plasma values and then determine insulin secretion curve. The first phase of insulin secretion was assessed by calculating insulin Area Under the Curve (AUC) between 0 and 5 minutes after glucose infusion (early insulin AUC). Insulin sensitivity was assessed by calculating the insulin AUC between the 60th and 240th minute (late insulin AUC) after glucose infusion.
Results: In group A, the first phase of insulin secretion promptly improved after SG, as expressed by the early insulin AUC increasing (from 130.55 ± 36.45 µUI ml-1 . min before surgery to 202.5 ± 62.15 µUI ml-1 • min, 3 days after surgery; p 0.04). Insulin sensitivity improved, as indicated by the reduction of late insulin AUC (from 6634 ± 4140.39 µUI • ml-1 • min to 3888 ± 1881.88 µUI • ml-1 • min, p 0.04). No significant changes were seen in group B.
Conclusions: SG modifies both insulin secretion and sensitivity immediately after surgery, before any food passage through the G.I. tract and before any weight loss. The effect of SG on DM seems to be directly related to the fundus ablation.
Program Number: P055