Key result
Gastric bypass surgery resulted in intermediate postprandial proinsulin AUC compared to morbidly obese and normal weight subjects (P for trend = 0.020).
Why the study?
Does gastric bypass surgery alter the dynamics of proinsulin and insulin secretion compared to morbid obesity and normal weight in subjects without diabetes?
Observational (n=32)
Does gastric bypass surgery alter the dynamics of proinsulin and insulin secretion compared to morbid obesity and normal weight in subjects without diabetes?
p-value: p=0.020
Gastric bypass surgery normalizes fasting proinsulin and improves postprandial proinsulin dynamics in previously morbidly obese subjects without diabetes.
May suggest partial normalization of proinsulin dynamics post-bypass in non-diabetics; hypothesis-generating and requires prospective validation before practice change.
AIMS: Hyperproinsulinaemia is associated with obesity and is a risk factor for Type 2 diabetes. We explored the dynamics of proinsulin and insulin and postprandial effects on glucose and lipids in subjects who had undergone gastric bypass (GBP) surgery compared with morbidly obese (MO) subjects and normal weight control subjects (NW). METHODS: Subjects free from diabetes were recruited: 10 previously MO subjects [body mass index (BMI) +/- sd, 34.8 +/- 6.2 kg/m2] who had undergone GBP surgery, 10 MO subjects (BMI 44 +/- 3.1 kg/m2) and 12 NW control subjects (BMI 23.2 +/- 2.4 kg/m2). After an overnight fast, a standard meal (2400 kJ) was ingested and glucose, proinsulin, insulin free fatty acids and triglycerides were determined up to 180 min. RESULTS: Fasting proinsulin was similar in the GBP group and NW control subjects, but threefold increased in MO subjects (P < 0.05). Postprandial AUC for glucose was similar in the three groups and AUC for proinsulin was high in MO, intermediate in the GBP group and lowest in NW control subjects (P for trend = 0.020). Postprandial proinsulin at 60 min was similar in the GBP group and MO subjects and twofold higher than in NW control subjects. Postprandial proinsulin at 180 min was normal in the GBP group, but fivefold increased in MO subjects (P = 0.008). Insulin increased rapidly at 30 min in the GBP group and was normal at 90 min, whereas insulin was still increased at 90-180 min in the MO subjects (P < 0.001). CONCLUSIONS: MO subjects, free from diabetes, have elevated proinsulin concentrations in the fasting as well as the postprandial phase. After GBP surgery markedly lower fasting and postprandial proinsulin concentrations were observed, although BMI was higher compared with NW control subjects.
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Johansson et al. (2007) conducted an observational in Obesity (n=32). Gastric bypass surgery vs. Morbidly obese subjects and normal weight control subjects was evaluated on Postprandial AUC for proinsulin (p=0.020). Gastric bypass surgery resulted in intermediate postprandial proinsulin AUC compared to morbidly obese and normal weight subjects (P for trend = 0.020).
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