AUTHOR=Luo Ping , Cao Yaoquan , Li Pengzhou , Wang Guohui , Song Zhi , Li Weizheng , Su Zhihong , Zhou Hui , Yi Xianhao , Fu Zhibing , Sun Xulong , Tang Haibo , Cui Beibei , Yu Qianqian , Zhu Liyong , Zhu Shaihong 

TITLE=Insulin Resistance Remission Following Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy in Chinese Type 2 Diabetes Mellitus Patients With a Body Mass Index of 27.5–32.5 kg/m2

JOURNAL=Frontiers in Physiology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2021.772577

DOI=10.3389/fphys.2021.772577

ISSN=1664-042X

ABSTRACT=<p><bold>Background:</bold> Insulin resistance (IR) is closely associated with the pathogenesis of type 2 diabetes mellitus (T2DM). However, remission of insulin sensitivity after bariatric surgery in patients with T2DM and a body mass index (BMI) of 27.5–32.5 kg/m<sup>2</sup> has not been fully elucidated.</p><p><bold>Methods:</bold> Thirty-six T2DM patients with a BMI of 27.5–32.5 kg/m<sup>2</sup> were prospectively consecutively recruited for laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG). Hyperinsulinemic euglycemic clamp, oral glucose tolerance test (OGTT), and other indicators were tested at baseline and 6 months postoperative. Glucose disposal rate (GDR), time to reach euglycemia, homeostatic model assessment of IR, quantitative insulin sensitivity check index (QUICKI), triglyceride glucose (TyG) index, 30-min insulinogenic index (IGI30), and disposition index (DI) were calculated at baseline and 6 months after surgery. The criterion for remission in T2DM patients was the achievement of the triple composite endpoint.</p><p><bold>Results:</bold> Anthropometric and glucolipid metabolism parameters significantly improved following surgery. The GDR increased significantly from baseline to 6 months after LRYGB (from 4.28 ± 1.70 mg/kg/min to 8.47 ± 1.89 mg/kg/min, <italic>p</italic> &lt; 0.0001) and LSG (from 3.18 ± 1.36 mg/kg/min to 7.09 ± 1.69 mg/kg/min, <italic>p</italic> &lt; 0.001). The TyG index decreased after surgery (RYGB group, from 9.93 ± 1.03 to 8.60 ± 0.43, <italic>p</italic> &lt; 0.0001; LSG group, from 10.04 ± 0.79 to 8.72 ± 0.65, <italic>p</italic> = 0.0002). There was a significant reduction in the IGI30 (RYGB group, from 2.04 ± 2.12 to 0.83 ± 0.47, <italic>p</italic> = 0.005; LSG group, from 2.12 ± 1.73 to 0.92 ± 0.66, <italic>p</italic> = 0.001). The mean DI significantly increased from 1.14 ± 1.35 to 7.11 ± 4.93 in the RYGB group (<italic>p</italic> = 0.0001) and from 1.25 ± 1.78 to 5.60 ± 4.58 in the LSG group (<italic>p</italic> = 0.003). Compared with baseline, HOMR-IR, QUICKI, area under the curve-C-peptide release test (AUC-CRT), and AUC-OGTT were significantly changed at 6 months postoperative. Overall, 52.63% of patients in the LRYGB group versus 29.41% of patients in the LSG group achieved the triple composite endpoint.</p><p><bold>Conclusion:</bold> Both LRYGB and LSG effectively induced remission of IR in patients with T2DM and a BMI of 27.5–32.5 kg/m<sup>2</sup>.</p>