Leonardou Angeliki S, Karystianos Christopher, Argyropoulos Christos, Nikiforidis George C, Kalfarentzos Fotis, Alexandrides Theodore K
Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece.
Department of Medical Physics, University of Patras Medical School, Patras, Greece.
Surg Obes Relat Dis. 2016 Sep-Oct;12(8):1539-1547. doi: 10.1016/j.soard.2016.04.009. Epub 2016 Apr 12.
Minimal glucose infusions are known to entrain insulin oscillations in patients with normal glucose tolerance (NGT) but not in patients with type 2 diabetes (T2D).
To investigate whether weight loss after a version of biliopancreatic diversion (BPD) can restore the glucose entrainment of high-frequency insulin oscillations in morbidly obese NGT or T2D patients.
University Hospital, Greece.
We prospectively studied 9 NGT controls (body mass index [BMI] 23.3±1.6 kg/m), 9 obese NGT patients (BMI 51.1±12.7 kg/m), and 9 obese T2D patients (BMI 56.8±11.6 kg/m). Patients were studied before and 1.5 years after BPD. Insulin was sampled every minute for 90 minutes. Glucose (6 mg/kg weight) was infused every 10 minutes for 1 minute. Regularity of insulin pulses was estimated by autocorrelation analysis, spectral analysis, approximate entropy/sample entropy (ApEn/SampEn), and insulin pulsatility by deconvolution analysis.
Postoperatively, glucose and insulin concentrations of NGT and T2D patients decreased to control levels and BMI to 31.3±6.3 for NGT patients and 34.9±9.9 kg/m for T2D patients. Preoperatively, glucose entrainment was absent in all T2D and in 4 NGT patients as assessed with spectral analysis and in 8 and 4, respectively, as assessed with autocorrelation and deconvolution analysis. Postoperatively, it was restored to normal in all patients. ApEn/SampEn decreased significantly only in the T2D group postoperatively.
BPD restores the glucose entrainment of high-frequency insulin oscillations in obese NGT and T2D patients after marked weight loss and normalizes glucose levels and insulin sensitivity, thus demonstrating recovery of β-cell glucose sensing.
已知微量葡萄糖输注可诱导糖耐量正常（NGT）患者的胰岛素振荡，但对2型糖尿病（T2D）患者无效。
研究一种胆胰转流术（BPD）后的体重减轻是否能恢复病态肥胖的NGT或T2D患者高频胰岛素振荡的葡萄糖诱导作用。
希腊大学医院。
我们前瞻性地研究了9名NGT对照者（体重指数[BMI]23.3±1.6kg/m²）、9名肥胖NGT患者（BMI51.1±12.7kg/m²）和9名肥胖T2D患者（BMI56.8±11.6kg/m²）。在BPD术前和术后1.5年对患者进行研究。每隔1分钟采集胰岛素样本，共采集90分钟。每隔10分钟输注1分钟葡萄糖（6mg/kg体重）。通过自相关分析、频谱分析、近似熵/样本熵（ApEn/SampEn）评估胰岛素脉冲的规律性，并通过去卷积分析评估胰岛素的搏动性。
术后，NGT和T2D患者的葡萄糖和胰岛素浓度降至对照水平，NGT患者的BMI降至31.3±6.3，T2D患者的BMI降至34.9±9.9kg/m²。术前，通过频谱分析评估，所有T2D患者和4名NGT患者均不存在葡萄糖诱导作用；通过自相关分析和去卷积分析评估，分别有8名和4名患者不存在葡萄糖诱导作用。术后，所有患者的葡萄糖诱导作用均恢复正常。仅T2D组术后ApEn/SampEn显著降低。
BPD术后体重显著减轻后，可恢复肥胖NGT和T2D患者高频胰岛素振荡的葡萄糖诱导作用，并使血糖水平和胰岛素敏感性正常化，从而证明β细胞葡萄糖感应功能得以恢复。
