Plourde Charles-Étienne, Grenier-Larouche Thomas, Caron-Dorval Dominique, Biron Simon, Marceau Simon, Lebel Stéfan, Biertho Laurent, Tchernof André, Richard Denis, Carpentier André C
Department of Medicine, Division of Endocrinology, Centre de recherche clinique Étienne-Le Bel, Université de Sherbrooke, Québec, Canada; Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada.
Obesity (Silver Spring). 2014 Aug;22(8):1838-46. doi: 10.1002/oby.20771. Epub 2014 Apr 24.
To assess the rapid improvement of insulin sensitivity and β-cell function following biliopancreatic diversion with duodenal switch (BPD-DS) and determine the role played by caloric restriction in these changes.
Standard meals were administrated before and on day 3, 4, and 5 after BPD-DS to measure total caloric intake, glucose excursion, insulin sensitivity, and secretion in matched type 2 diabetes and normoglycemic (NG) subjects. In a second set of study, other subjects with type 2 diabetes had the same meal tests prior to and after a 3-day caloric restriction identical to that observed after BPD-DS and then 3 days after actually undergoing BPD-DS.
Improvement of HOMA-IR occurred at day 3 after BPD-DS in diabetes and after 3 days of caloric restriction. The disposition index (DI) improved rapidly in diabetes after BPD-DS and to a similar extent after caloric restriction. DI was higher and did not change after BPD-DS in NG. Changes in glucagon-like peptide-1, gastric inhibitory peptide, peptide tyrosine tyrosine, ghrelin, and pancreatic polypeptide levels were not associated with modulation of DI in the participants.
Caloric restriction is the major mechanism underlying the early improvement of insulin sensitivity and β-cell function after BPD-DS in type 2 diabetes.
评估胆胰转流十二指肠转位术（BPD-DS）后胰岛素敏感性和β细胞功能的快速改善情况，并确定热量限制在这些变化中所起的作用。
在BPD-DS前以及术后第3、4和5天给予标准餐，以测量匹配的2型糖尿病和血糖正常（NG）受试者的总热量摄入、血糖波动、胰岛素敏感性和分泌。在第二项研究中，其他2型糖尿病受试者在与BPD-DS后观察到的相同热量限制3天之前和之后，以及实际接受BPD-DS后3天进行相同的进餐测试。
在糖尿病患者中，BPD-DS后第3天以及热量限制3天后，HOMA-IR有所改善。在糖尿病患者中，BPD-DS后处置指数（DI）迅速改善，热量限制后也有类似程度的改善。在NG受试者中，BPD-DS后DI较高且无变化。胰高血糖素样肽-1、胃抑制肽、肽YY、胃饥饿素和胰多肽水平的变化与参与者DI的调节无关。
热量限制是2型糖尿病患者BPD-DS后胰岛素敏感性和β细胞功能早期改善的主要机制。
