Restoration of Euglycemia and Normal Acute Insulin Response to Glucose in Obese Subjects With Type 2 Diabetes Following Bariatric Surgery

  1. Eftihia V. Polyzogopoulou1,
  2. Fotios Kalfarentzos2,
  3. Apostolos G. Vagenakis1 and
  4. Theodore K. Alexandrides1
  1. 1Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
  2. 2Nutrition Support and Morbid Obesity Clinic, Department of Surgery, University of Patras Medical School, Patras, Greece


    Insulin resistance and loss of glucose-stimulated acute insulin response (AIR) are the two major and earliest defects in the course of type 2 diabetes. We investigated whether weight loss after bariatric surgery in patients with morbid obesity and type 2 diabetes could restore euglycemia and normal AIR to an intravenous glucose tolerance test (IVGTT). We studied 25 morbidly obese patients—12 with type 2 diabetes, 5 with impaired glucose tolerance, and 8 with normal glucose tolerance (NGT)—before and after a biliopancreatic diversion (BPD) with Roux-en-Y gastric bypass (RYGBP). Twelve individuals with normal BMI served as control subjects. Twelve months after surgery, in the diabetes group, BMI decreased from 53.2 ± 2.0 to 29.2 ± 1.7 kg/m2, fasting glucose decreased from 9.5 ± 0.83 to 4.5 ± 0.13 mmol/l, and fasting insulin decreased from 168.4 ± 25.9 to 37.7 ± 4.4 pmol/l (mean ± SE; P < 0.001). AIR, the mean of insulin concentration at 2, 3, and 5 min over basal in the IVGTT, increased by 770 and 935% at 3 and 12 months after surgery, respectively (from 24.0 ± 22.7 to 209 ± 43.4 and 248 ± 33.1 pmol/l, respectively; P < 0,001). Conversely, in the NGT group, the AIR decreased by 40.5% (from 660 ± 60 to 393 ± 93 pmol/l; P = 0.027) 12 months after surgery. BPD with RYGBP performed in morbidly obese patients with type 2 diabetes leads to significant weight loss, euglycemia, and normal insulin sensitivity; but most importantly, it restores a normal β-cell AIR to glucose and a normal relationship of AIR to insulin sensitivity. This is the first study to demonstrate that the lost glucose-induced AIR in patients with type 2 diabetes of mild or moderate severity is a reversible abnormality.


    • Address correspondence and reprint requests to Theodore K. Alexandrides, Associate Professor of Medicine, Department of Internal Medicine, University Hospital of Patras, Rion, 26500, Greece. E-mail: thalex{at}

      Received for publication 17 October 2002 and accepted in revised form 11 February 2003.

      AIR, acute insulin response; BPD, biliopancreatic diversion; FFM, fat-free mass; IGT, impaired glucose tolerance; IVGTT, intravenous glucose tolerance test; NGT, normal glucose tolerance; OGTT, oral glucose tolerance test; QUICKI, Quantitative Insulin Sensitivity Check Index; RYGBP, Roux-en-Y gastric bypass

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