Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

Long-term normalization of insulin sensitivity following biliopancreatic diversion for obesity

Abstract

OBJECTIVE: Assess insulin sensitivity and metabolic status of obese patients with stable weight loss at long term following biliopancreatic diversion (BPD).

MATERIAL AND METHODS: The study was carried out in 36 nondiabetic severely obese patients undergoing BPD. Serum concentration of glucose, insulin and leptin were determined prior to and at 2 y following the operation. Insulin sensitivity was calculated according to the homeostatic model assessment (HOMA IR).

RESULTS: At 2 y following BPD, weight loss in all subjects corresponded to a marked drop in serum leptin concentration and improvement of insulin sensitivity within physiological range. Following the operation, HOMA IR values were positively correlated with serum leptin concentration independently of body mass index values.

DISCUSSION: The stable weight loss following BPD at long term is accompanied by a complete reversal of the preoperative insulin resistance. Serum leptin concentration and HOMA IR data were positively related only postoperatively, suggesting that the action of factors that could influence the relation between leptin and insulin action in the obese status can be reverted.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Ferrannini E, Natali A, Bell P, Cavallo-Perin P, Lalic N, Mingrone G . Insulin resistance and hypersecretion in obesity. J Clin Invest 1997; 100: 1166–1173.

    Article  CAS  Google Scholar 

  2. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393–403.

  3. Scopinaro N, Adami GF, Marinari UM, Gianetta E, Traverso E, Friedman D . Biliopancreatic diversion. World J Surg 1998; 22: 936–946.

    Article  CAS  Google Scholar 

  4. Mingrone G, DeGaetano A, Greco AV, Capristo E, Benedetti G, Castagneto M . Reversibility of insulin resistance in obese diabetic patients: role of plasma lipids. Diabetologia 1997; 40: 599–605.

    Article  CAS  Google Scholar 

  5. Greco AV, Mingrone G, Giancaterini A, Manco M, Morroni M, Cinti S, Granzotto M, Vettor R, Camastra S, Ferrannini E . Insulin resistance in morbid obesity: reversal with intramyocellular fat depletion. Diabetes 2002; 51: 144–151.

    Article  CAS  Google Scholar 

  6. Ceddia RB, Koistinen HI, Zierath JR, Sweeney G . Analysis of paradoxical observations on the association between leptin and insulin resistance. FASEB J 2002; 16: 1163–1176.

    Article  CAS  Google Scholar 

  7. Leclerq-Meyer V, Malaisse WJ . Failure of human and mouse leptin to affect insulin, glucagon and somatostatin secretion by the perfused rat pancreas at physiological glucose concentration. Mol Cell Endocrinol 1998; 141: 111–118.

    Article  Google Scholar 

  8. Tanizava Y, Okuya S, Ishihara H, Asano T, Yada T, Oka Y . Direct stimulation of basal insulin secretion by physiological concentration of leptin in pancreatic beta cells. Endocrinology 1997; 138: 4513–4516.

    Article  Google Scholar 

  9. Haffner SM, Miettinen H, Stern MP . The homeostasis model in the San Antonio Heart Study. Diabetes Care 1997; 20: 1087–1092.

    Article  CAS  Google Scholar 

  10. Scopinaro N, Marinari GM, Camerini G, Papadia F, Murelli F, Marini P, Adami GF . Energy and nitrogen absorption after biliopancreatic diversion. Obes Surg. 2000; 10: 436–441.

    Article  CAS  Google Scholar 

  11. Rubino F, Gagner M . Potential of surgery for curing type 2 diabetes mellitus. Ann Surg 2002; 236: 554–559.

    Article  Google Scholar 

  12. Sarson DL, Scopinaro N, Bloom SR . Gut hormone changes after jeunoileal or biliopancreatic bypass surgery for morbid obesity. Int J Obes 1981; 5: 471–476.

    CAS  PubMed  Google Scholar 

  13. Hichey Ms, Pories WJ, MacDonald KG, Cory KA, Dohm GL, Swanson MS, Israel RG, Barakat HA, Considine RV, Caro JF, Houmard JA . A new paradigm for type 2 diabetes mellitus: could it be a disease of the foregut? Ann Surg 1998; 227: 637–644.

    Article  Google Scholar 

  14. Poires WJ, MacDonald KG, Morgan EJ, Long SB, Morris PG, Brown BM, Barakat HA, deRamon RA, Israel G, Dolezal JM . Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995; 222: 239–350.

    Google Scholar 

  15. Liuzzi A, Savia G, Tagliaferro M, Lucantoni R, Berselli BE, Petroni ML, DeMedici C, Viberti GC . Serum leptin concentration in moderate and severe obesity: relationship with clinical, anthropometric and metabolic factors. Int J Obes Relat Metab Disord 1999; 23: 1066–1073.

    Article  CAS  Google Scholar 

  16. Larsson H, Ehmstahl S, Ahren B . Plasma leptin levels correlate to islet function independently of body fat in postmenopausal women. Diabetes 1996; 45: 1580–1584.

    Article  CAS  Google Scholar 

  17. Haffner SM, Miettinen H, Mykkänen I, Karhapää P, Rainwater DL, Laasko M . Leptin concentrations and insulin sensitivity in normoglycemic men. Int J Obes Relat Metab Disord 1997; 21: 393–399.

    Article  CAS  Google Scholar 

  18. Guven S, El-Bershawi A, Sonnenberg CE, Wilson CR, Hoffmann RG, Krakower GR, Kissebah AH . Plasma leptin and insulin levels in weight reduced obese women with normal body mass index: relationships with body composition and insulin. Diabetes 1999; 46: 347–352.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to G F Adami.

Additional information

No outside funding was used for this study

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adami, G., Cordera, R., Camerini, G. et al. Long-term normalization of insulin sensitivity following biliopancreatic diversion for obesity. Int J Obes 28, 671–673 (2004). https://doi.org/10.1038/sj.ijo.0802618

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0802618

Keywords

This article is cited by

Search

Quick links