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Am J Physiol Endocrinol Metab 284: E557-E565, 2003; doi:10.1152/ajpendo.00325.2002
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Vol. 284, Issue 3, E557-E565, March 2003

Improved beta -cell function after standardized weight reduction in severely obese subjects

Marie Guldstrand1, Bo Ahrén2, and Ulf Adamson1

1 Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, SE-182 88 Danderyd; and 2 Department of Medicine, Lund University, SE-221 84 Lund, Sweden

Islet function was examined in 13 severely obese women [body mass index 46.4 ± 5.5 (SD) kg/m2] before and after standardized 15 and 25% weight reduction (WR) instituted by bariatric surgery. The insulin response to arginine at fasting (AIR1), at 14 mmol/l, and at >25 mmol/l glucose was reduced by 37-50% after 15 and 25% WR (P <=  0.05). Insulin sensitivity was determined as the amount of glucose infused to reach 14 mmol/l divided by the insulin level (M/I), a measure showing a linear correlation with insulin sensitivity during euglycemic hyperinsulinemic clamps (r = 0.74, P < 0.001) and a hyperbolic relation to AIR1 (r = -0.63, P < 0.001) in 169 healthy subjects. M/I was increased by 318 ± 182% after 15% (P = 0.004) and by 489 ± 276% after 25% WR (P = 0.007). The reduction in insulin secretion was not as large as anticipated from the increased insulin sensitivity, which resulted in an increased disposition index (DI; AIR1 × M/I). Thus DI increased by 95 ± 24% after 15% (P = 0.018) and by 176 ± 35% after 25% WR (P = 0.011). This improved beta -cell function correlated independently with reduced glucose, triglycerides, and leptin and increased adiponectin levels and was associated with a reduced proinsulin-to-insulin ratio. In contrast, glucagon secretion was not significantly affected by WR. We conclude that WR results in improved beta -cell function when related to insulin sensitivity.

insulin secretion; glucagon secretion; obesity; glucose tolerance


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