A prospective evaluation of the influence of three bariatric procedures on insulin resistance improvement. Should the extent of undiluted bile transit be considered a key postoperative factor altering glucose metabolism?

Łukasz Kaska; Monika Proczko; Piotr Wiśniewski; Marta Stankiewicz; Derek Gill; Zbigniew Śledziński

doi:10.5114/wiitm.2015.52062

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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abstract:

Original paper

A prospective evaluation of the influence of three bariatric procedures on insulin resistance improvement. Should the extent of undiluted bile transit be considered a key postoperative factor altering glucose metabolism?

Łukasz Kaska

,

Monika Proczko

,

Piotr Wiśniewski

,

Marta Stankiewicz

,

Derek Gill

,

Zbigniew Śledziński

Videosurgery Miniinv 2015; 10 (2): 213–228

DOI: https://doi.org/10.5114/wiitm.2015.52062

Online publish date: 2015/06/08

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AMA

Kaska Ł, Proczko M, Wiśniewski P, Stankiewicz M, Gill D, Śledziński Z. A prospective evaluation of the influence of three bariatric procedures on insulin resistance improvement. Should the extent of undiluted bile transit be considered a key postoperative factor altering glucose metabolism?. Videosurgery and Other Miniinvasive Techniques. 2015:213-228. doi:10.5114/wiitm.2015.52062.

APA

Kaska, Ł., Proczko, M., Wiśniewski, P., Stankiewicz, M., Gill, D.,  & Śledziński, Z. (2015). A prospective evaluation of the influence of three bariatric procedures on insulin resistance improvement. Should the extent of undiluted bile transit be considered a key postoperative factor altering glucose metabolism?. Videosurgery and Other Miniinvasive Techniques, 213-228. https://doi.org/10.5114/wiitm.2015.52062

Chicago

Kaska, Łukasz, Monika Proczko, Piotr Wiśniewski, Marta Stankiewicz, Derek Gill,  and Zbigniew Śledziński. 2015. "A prospective evaluation of the influence of three bariatric procedures on insulin resistance improvement. Should the extent of undiluted bile transit be considered a key postoperative factor altering glucose metabolism?". Videosurgery and Other Miniinvasive Techniques: 213-228. doi:10.5114/wiitm.2015.52062.

Harvard

Kaska, Ł., Proczko, M., Wiśniewski, P., Stankiewicz, M., Gill, D.,  and Śledziński, Z. (2015). A prospective evaluation of the influence of three bariatric procedures on insulin resistance improvement. Should the extent of undiluted bile transit be considered a key postoperative factor altering glucose metabolism?. Videosurgery and Other Miniinvasive Techniques, pp.213-228. https://doi.org/10.5114/wiitm.2015.52062

MLA

Kaska, Łukasz et al. "A prospective evaluation of the influence of three bariatric procedures on insulin resistance improvement. Should the extent of undiluted bile transit be considered a key postoperative factor altering glucose metabolism?." Videosurgery and Other Miniinvasive Techniques, 2015, pp. 213-228. doi:10.5114/wiitm.2015.52062.

Vancouver

Kaska Ł, Proczko M, Wiśniewski P, Stankiewicz M, Gill D, Śledziński Z. A prospective evaluation of the influence of three bariatric procedures on insulin resistance improvement. Should the extent of undiluted bile transit be considered a key postoperative factor altering glucose metabolism?. Videosurgery and Other Miniinvasive Techniques. 2015:213-228. doi:10.5114/wiitm.2015.52062.

PlumX metrics:

Introduction: Insulin resistance (IR), the essential step in development of type 2 diabetes mellitus (T2DM), resolves quickly after bariatric surgery, but the effectiveness depends on the type of the procedure. Although the long-term influence on IR improvement is well documented, the mechanisms of the ultra-fast response after restrictive and bypass procedures require explanation.

Aim: To determine IR evolution from the initial preparative period to 6 months after the operation, exposing the rapid postoperative response while comparing the 3 bariatric methods, with the belief that the metabolic effect may be correlated with anatomical combinations.

Material and methods: From January to December, 2013, a cohort of severely obese, insulin resistant individuals recruited to the prospective study underwent laparoscopic sleeve gastrectomy (SG-30), Roux-en-Y gastric bypass (RYGB-30) and one-anastomosis gastric bypass (OAGB-30). Main laboratory parameters of glucose metabolism were evaluated in fasting patients preoperatively, 4 days and 1, 3 and 6 months after surgery.

Results: Within the whole observation period the most significant improvement in homeostasis model assessment for IR (HOMA-IR) was observed in the first 4 days after each operation. The decrease of HOMA-IR was higher (p < 0.0001) in gastric bypass groups than in patients after SG (–41%). The difference between bypass groups favors OAGB over RYGB (63 vs. –56%, p = 0.0489).

Conclusions: Among all bariatric management factors, operation type is the most important in IR improvement. The significant difference in response after SG vs. RYGB and OAGB supports the concept of metabolic competence of duodeno-jejunal exclusion. Altered bile flow after duodeno-jejunal exclusion may be responsible for enhanced glucose metabolism improvement.

keywords:

insulin resistance, type 2 diabetes mellitus, sleeve gastrectomy, Roux-en-Y gastric bypass, one-anastomosis gastric bypass, homeostasis model assessment for insulin resistance , role of bile

A prospective evaluation of the influence of three bariatric procedures on insulin resistance improvement. Should the extent of undiluted bile transit be considered a key postoperative factor altering glucose metabolism?

Łukasz Kaska , Monika Proczko , Piotr Wiśniewski , Marta Stankiewicz , Derek Gill , Zbigniew Śledziński

insulin resistance, type 2 diabetes mellitus, sleeve gastrectomy, Roux-en-Y gastric bypass, one-anastomosis gastric bypass, homeostasis model assessment for insulin resistance , role of bile

Łukasz Kaska

,

Monika Proczko

,

Piotr Wiśniewski

,

Marta Stankiewicz

,

Derek Gill

,

Zbigniew Śledziński