Department of Endocrinology and Medicine, University of Genova, Genoa, Italy.
Obesity (Silver Spring). 2010 May;18(5):932-6. doi: 10.1038/oby.2010.28. Epub 2010 Feb 25.
In subjects with obesity and type 2 diabetes mellitus (T2DM), biliopancreatic diversion (BPD) improves glucose stimulated insulin secretion, whereas the effects on other secretion mechanisms are still unknown. Our objective was to evaluate the early effects of BPD on nonglucose-stimulated insulin secretion. In 16 morbid obese subjects (9 with T2DM and 7 with normal fasting glucose (NFG)), we measured insulin secretion after glucose-dependent arginine stimulation test and after intravenous glucose tolerance test (IVGTT) before and 1 month after BPD. After surgery the mean weight lost was 13% in both groups. The acute insulin response during IVGTT was improved in T2DM after BDP (from 55 +/- 10 to 277 +/- 91 pmol/l, P = 0.03). A reduction of insulin response to arginine was observed in NFG, whereas opposite was found in T2DM. In particular, acute insulin response to arginine at basal glucose concentrations (AIR(basal)) was reduced but insulin response at 14 mmol/l of plasma glucose (AIR(14)) was increased. Therefore, after BPD any statistical difference in AIR(14) between NFG and T2DM disappeared (1,032 +/- 123 for NFG and 665 +/- 236 pmol/l for T2DM, P = ns). The same was observed for Slope(AIR), a measure of glucose potentiation, reduced in T2DM before BPD but increased after surgery, when no statistically significant difference resulted compared with NFG (Slope(AIR) after BPD: 78 +/- 11 in NFG and 56 +/- 18 pmol/l in T2DM, P = ns). In conclusion, in obese T2DM subjects 1 month after BPD we observed a great improvement of both glucose- and nonglucose-stimulated insulin secretions. The mechanisms by which BDP improve insulin secretion are still unknown.
在肥胖和 2 型糖尿病（T2DM）患者中，胆胰分流术（BPD）改善了葡萄糖刺激的胰岛素分泌，而其他分泌机制的影响仍不清楚。我们的目的是评估 BPD 对非葡萄糖刺激的胰岛素分泌的早期影响。在 16 例病态肥胖患者（9 例 T2DM，7 例空腹血糖正常（NFG））中，我们在 BPD 前后 1 个月测量了葡萄糖依赖性精氨酸刺激试验和静脉葡萄糖耐量试验（IVGTT）后的胰岛素分泌。手术后，两组的平均体重减轻了 13%。T2DM 患者在 BDP 后 IVGTT 中的急性胰岛素反应得到改善（从 55 ± 10 增加到 277 ± 91 pmol/L，P = 0.03）。在 NFG 中观察到对精氨酸的胰岛素反应减少，而在 T2DM 中则相反。特别是，在基础血糖浓度下的急性胰岛素反应（AIR（basal））降低，但在 14 mmol/L 的血糖水平下的胰岛素反应（AIR（14））增加。因此，在 BPD 后，NFG 和 T2DM 之间在 AIR（14）方面的任何统计学差异都消失了（NFG 为 1032 ± 123 pmol/L，T2DM 为 665 ± 236 pmol/L，P = ns）。同样的情况也发生在葡萄糖增强的测量指标 Slope（AIR）上，在 T2DM 患者的术前 BPD 中降低，但在手术后增加，与 NFG 相比没有统计学差异（BPD 后的 Slope（AIR）：NFG 为 78 ± 11 pmol/L，T2DM 为 56 ± 18 pmol/L，P = ns）。总之，在肥胖的 T2DM 患者中，BPD 后 1 个月，我们观察到葡萄糖和非葡萄糖刺激的胰岛素分泌都有了很大的改善。BPD 改善胰岛素分泌的机制尚不清楚。
