Journal
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
Volume 28, Issue 5, Pages 1489-1493Publisher
SPRINGER
DOI: 10.1007/s00464-013-3338-0
Keywords
Bariatric surgery; Laparoscopic Roux-en-Y gastric bypass; Free fatty acid; Insulin sensitivity; Insulin resistance; Total body fat; Adiposity
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Funding
- NIDDK NIH HHS [K23 DK075907] Funding Source: Medline
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Increased plasma free fatty acids (FFAs) are considered one of the key elements in the pathogenesis of insulin resistance (IR) and type 2 diabetes (T2DM). We hypothesize that, in diabetic patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB), a postoperative decrease in FFA will correlate with improved insulin sensitivity (Si). A total of 30 obese [body mass index ((BMI) > 35 kg/m(2)] patients with a diagnosis of T2DM were studied preoperatively and 12 months after LRYGB in a prospective cohort study. Collected data included intravenous glucose tolerance test (IVGTT), total body composition by dual-energy X-ray absorptiometry and plasma levels of FFA. Si analysis from the IVGTT was estimated from minimal model analysis. Pre- and postoperative variables were compared using a paired sample t test. Relationships between changes in variables were determined with Pearson's correlation test. Twelve months after LRYGB the study population showed a significant decrease in BMI (p = 0.001), FFA (p = 0.03), and total body fat (p = 0.03), with an increase in Si (p = 0.001). Postoperative changes in Si significantly correlated (Pearson's r = -0.53, p = 0.01) with change in total body fat, but not with changes in plasma FFA (Pearson's r = -0.22, p = 0.31). Our study challenges the notion that IR is mediated to a significant degree by changes in plasma FFA concentration. Instead, changes in adiposity and consequently changes in adipokine release can be the key players in determining remission of T2DM after LRYGB.
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