Metabolic characterization of nondiabetic severely obese patients undergoing Roux-en-Y gastric bypass: preoperative classification predicts the effects of gastric bypass on insulin-glucose homeostasis
Authors
Perugini, Richard A.Quarfordt, Steven H.
Baker, Stephen P.
Czerniach, Donald R.
Litwin, Demetrius E. M.
Kelly, John J.
UMass Chan Affiliations
Department of SurgeryDepartment of Cell Biology
Information Services, Academic Computing Services
Document Type
Journal ArticlePublication Date
2007-06-26Keywords
Adipose TissueAdult
B-Lymphocytes
Body Mass Index
Chemiluminescent Measurements
Female
Gastric Bypass
Glucose
Homeostasis
Humans
Immunoassay
Insulin
Insulin Resistance
Male
Middle Aged
Obesity, Morbid
Gastroenterology
Surgery
Metadata
Show full item recordAbstract
INTRODUCTION: Obese individuals may have normal insulin-glucose homeostasis, insulin resistance, or diabetes mellitus. Whereas gastric bypass cures insulin resistance and diabetes mellitus, its effects on normal physiology have not been described. We studied insulin resistance and beta-cell function for patients undergoing gastric bypass. METHODS: One hundred thirty-eight patients undergoing gastric bypass had fasting insulin and glucose levels drawn on days 0, 12, 40, 180, and 365. Thirty-one (22%) patients with diabetes mellitus were excluded from this analysis. Homeostatic model of assessment was used to estimate insulin resistance, insulin sensitivity, and beta-cell function. Based on this model, patients were categorized as high insulin resistance if their insulin resistance was >2.3. RESULTS: Body mass index did not correlate with insulin resistance. Forty-seven (34%) patients were categorized as high insulin resistance. Correction of insulin resistance for this group occurred by 12 days postoperatively. Sixty (43%) patients were categorized as low insulin resistance. They demonstrated an increase of beta-cell function by 12 days postoperatively, which returned to baseline by 6 months. At 1 year postoperatively, the low insulin resistance group had significantly higher beta-cell function per degree of insulin sensitivity. CONCLUSIONS: Adipose mass alone cannot explain insulin resistance. Severely obese individuals can be categorized by degree of insulin resistance, and the effect of gastric bypass depends upon this preoperative physiology.Source
J Gastrointest Surg. 2007 Sep;11(9):1083-90. Link to article on publisher's siteDOI
10.1007/s11605-007-0158-3Permanent Link to this Item
http://hdl.handle.net/20.500.14038/35319PubMed ID
17588192Related Resources
Link to article in PubMedae974a485f413a2113503eed53cd6c53
10.1007/s11605-007-0158-3