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Diabetes 53:S26-S33, 2004
© 2004 by the American Diabetes Association, Inc.

Section I: Insulin Resistance-Beta-Cell Connection in Type 2 Diabetes

Beta-Cell Function in Obesity

Effects of Weight Loss

Ele Ferrannini1, Stefania Camastra1, Amalia Gastaldelli1, Anna Maria Sironi1, Andrea Natali1, Elza Muscelli1, Geltrude Mingrone2, and Andrea Mari3

1 Department of Internal Medicine and CNR Institute of Clinical Physiology, University of Pisa School of Medicine, Pisa, Italy
2 Department of Internal Medicine, Catholic University, School of Medicine, Rome, Italy
3 CNR Institute of Biomedical Engineering, Padova, Italy

In nondiabetic subjects, obesity is associated with a modest expansion of ß-cell mass, possibly amounting—according to the best available estimates—to 10–30% for each 10 kg of weight excess. Whether age of onset and duration of obesity, recent changes in body weight, and body fat distribution have any effect on ß-cell mass in humans is unknown. Both fasting insulin secretion and the total insulin response to oral glucose have the following characteristics: 1) they increase with BMI in an approximately linear fashion, 2) both fat-free and fat mass are significant positive correlates, and 3) BMI exerts a positive effect separate from that of insulin resistance (i.e., obesity may be a state of primary insulin hypersecretion). The mechanisms are currently unknown, though chronic small increments in plasma glucose may play a role. In contrast, dynamic properties of ß-cell function, such as glucose sensitivity (i.e., dose-response function), rate sensitivity, and potentiation, do not appear to be substantially altered by the presence of obesity, body fat distribution, or insulin resistance as long as glucose tolerance is maintained. Weight loss, by diet or restrictive bariatric surgery, is associated with consensual decrements in insulin resistance and insulin hypersecretion. The latter, however, seems to be more persistent, suggesting that the postobese state may reproduce the primary insulin hypersecretion of the obese state. Malabsorptive bariatric surgery, in contrast, normalizes insulin sensitivity and abolishes insulin hypersecretion even before achievement of ideal body weight. Lipid-triggered messages from the gastrointestinal tract to the insulin target tissues and endocrine pancreas are the subject of intense investigation.

Address correspondence and reprint requests to Ele Ferrannini, MD, Department of Internal Medicine, Via Savi, 8, 56126 Pisa, Italy. E-mail: ferranni{at}ifc.cnr.it


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Copyright © 2004 by the American Diabetes Association.