Heidi Immonen1, Jarna C Hannukainen2, Patricia Iozzo3, Minna Soinio1, Paulina Salminen4, Virva Saunavaara2, Ronald Borra5, Riitta Parkkola6, Andrea Mari7, Terho Lehtimäki8, Tam Pham2, Jukka Laine9, Vesa Kärjä10, Jussi Pihlajamäki11, Lassi Nelimarkka12, Pirjo Nuutila13. 1. Turku PET Centre, Turku, Finland; Department of Medicine, Turku University Hospital, Turku, Finland. 2. Turku PET Centre, Turku, Finland. 3. Institute of Clinical Physiology, National Research Council, Pisa, Italy. 4. Department of Surgery, Turku University Hospital, Turku, Finland. 5. Turku PET Centre, Turku, Finland; Department of Radiology, Turku University Hospital, Turku, Finland. 6. Department of Radiology, Turku University Hospital, Turku, Finland. 7. Institute of Biomedical Engineering, Padua, Italy. 8. Department of Clinical Chemistry, Finlab Laboratories, Tampere University Hospital and University of Tampere School of Medicine, Finland. 9. Department of Pathology, Turku University Hospital, Turku, Finland. 10. Department of Pathology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland. 11. Department of Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland. 12. Department of Medicine, Turku University Hospital, Turku, Finland. 13. Turku PET Centre, Turku, Finland; Department of Medicine, Turku University Hospital, Turku, Finland. Electronic address: pirjo.nuutila@utu.fi.
Abstract
BACKGROUND & AIMS:Bariatric surgery reduces weight and improves glucose metabolism in obese patients. We investigated the effects of bariatric surgery on hepatic insulin sensitivity. METHODS: Twenty-three morbidly obese (nine diabetic and fourteen non-diabetic) patients and ten healthy, lean control subjects were studied using positron emission tomography to assess hepatic glucose uptake in the fasting state and during euglycemic hyperinsulinemia. Magnetic resonance spectroscopy was performed to measure liver fat content and magnetic resonance imaging to obtain liver volume. Obese patients were studied before bariatric surgery (either sleeve gastrectomy or Roux-en-Y gastric bypass) and six months after surgery. RESULTS:Insulin-induced hepatic glucose uptake was increased by 33% in non-diabetic and by 36% in diabetic patients at follow-up compared with baseline, but not totally normalized. The liver fat content was reduced by 76%, liver volume by 26% and endogenous glucose production by 19% in non-diabetic patients. The respective changes in diabetic patients were 73%, 24%, and 25%. Postoperatively, liver fat content and endogenous glucose production were almost normalized to lean controls, but liver volume remained greater than in control subjects. CONCLUSIONS: This study shows that bariatric surgery leads to a significant improvement in hepatic insulin sensitivity: insulin-stimulated hepatic glucose uptake was improved and endogenous glucose production reduced when measured, six-months, after surgery. These metabolic effects were accompanied by a marked reduction in hepatic volume and fat content. Overall, the gain in hepatic insulin sensitivity in diabetic patients was quite similar to non-diabetic patients for the same weight reduction.
RCT Entities:
BACKGROUND & AIMS: Bariatric surgery reduces weight and improves glucose metabolism in obesepatients. We investigated the effects of bariatric surgery on hepatic insulin sensitivity. METHODS: Twenty-three morbidly obese (nine diabetic and fourteen non-diabetic) patients and ten healthy, lean control subjects were studied using positron emission tomography to assess hepatic glucose uptake in the fasting state and during euglycemic hyperinsulinemia. Magnetic resonance spectroscopy was performed to measure liver fat content and magnetic resonance imaging to obtain liver volume. Obesepatients were studied before bariatric surgery (either sleeve gastrectomy or Roux-en-Y gastric bypass) and six months after surgery. RESULTS: Insulin-induced hepatic glucose uptake was increased by 33% in non-diabetic and by 36% in diabeticpatients at follow-up compared with baseline, but not totally normalized. The liver fat content was reduced by 76%, liver volume by 26% and endogenous glucose production by 19% in non-diabeticpatients. The respective changes in diabeticpatients were 73%, 24%, and 25%. Postoperatively, liver fat content and endogenous glucose production were almost normalized to lean controls, but liver volume remained greater than in control subjects. CONCLUSIONS: This study shows that bariatric surgery leads to a significant improvement in hepatic insulin sensitivity: insulin-stimulated hepatic glucose uptake was improved and endogenous glucose production reduced when measured, six-months, after surgery. These metabolic effects were accompanied by a marked reduction in hepatic volume and fat content. Overall, the gain in hepatic insulin sensitivity in diabeticpatients was quite similar to non-diabeticpatients for the same weight reduction.
Authors: Dennis M Hedderich; Till Hasenberg; Stefan Haneder; Stefan O Schoenberg; Özlem Kücükoglu; Ali Canbay; Mirko Otto Journal: Obes Surg Date: 2017-07 Impact factor: 4.129
Authors: Sanna M Honkala; Jarkko Johansson; Kumail K Motiani; Jari-Joonas Eskelinen; Kirsi A Virtanen; Eliisa Löyttyniemi; Juhani Knuuti; Pirjo Nuutila; Kari K Kalliokoski; Jarna C Hannukainen Journal: J Cereb Blood Flow Metab Date: 2017-09-29 Impact factor: 6.200