Effect of Bariatric Surgery on Adipose Tissue Glucose Metabolism in Different Depots in Patients With or Without Type 2 Diabetes.

Abstract

OBJECTIVE:

We investigated fat distribution and tissue-specific insulin-stimulated glucose uptake (GU) in seven fat compartments (visceral and subcutaneous) and skeletal muscle in morbidly obese patients with (T2D) and without (ND) type 2 diabetes before and 6 months after bariatric surgery.

RESEARCH DESIGN AND METHODS:

A total of 23 obese patients (BMI 43.0 ± 3.6 kg/m(2); 9 T2D and 14 ND) were recruited from a larger, randomized multicenter SLEEVEPASS study. MRI (for fat distribution) and [(18)F]-fluorodeoxyglucose PET (for GU) studies were performed for the obese patients before and 6 months postsurgery; 10 lean subjects served as control subjects and were studied once.

RESULTS:

At baseline, visceral fat GU was 30 ± 7% of muscle GU in control subjects and 57 ± 5% in obese patients. Visceral and deep subcutaneous fat were more abundant (despite same total fat mass) and less insulin sensitive in T2D than ND; in both, GU was impaired compared with control subjects. Postsurgery, visceral fat mass decreased (∼40%) more than subcutaneous fat (7%). Tissue-specific GU was improved, but not normalized, at all sites in T2D and ND alike. The contribution of visceral fat to whole-body GU was greater in T2D than ND but decreased similarly with surgery. Subcutaneous fat made a fourfold greater contribution to whole-body GU in obese versus lean subjects (15% vs. 4%) both before and after surgery.

CONCLUSIONS:

Bariatric surgery leads to sustained weight loss and improves tissue-specific glucose metabolism in morbidly obese patients. We conclude that 1) enhanced visceral fat accumulation is a feature of T2D, 2) severe obesity compromises muscle insulin sensitivity more than fat insulin sensitivity, and 3) fat mass expansion is a sink for plasma glucose.

• Authors: Prince Dadson, Linda Landini, Mika Helmiö, Jarna C Hannukainen, Heidi Immonen, Miikka-Juhani Honka, Marco Bucci, Nina Savisto, Minna Soinio, Paulina Salminen, Riitta Parkkola, Jussi Pihlajamäki, Patricia Iozzo, Ele Ferrannini, Pirjo Nuutila
• Journal: Diabetes care (Diabetes Care) Vol. 39 Issue 2 Pg. 292-9 (Feb 2016) ISSN: 1935-5548 [Electronic] United States
• PMID: 26681717 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Chemical References

• Insulin
• Glucose

Topics

• Adult
• Bariatric Surgery
• Diabetes Mellitus, Type 2 (complications, surgery)
• Female
• Glucose (metabolism)
• Humans
• Insulin (blood)
• Insulin Resistance (physiology)
• Intra-Abdominal Fat (metabolism)
• Male
• Middle Aged
• Muscle, Skeletal (metabolism)
• Obesity, Morbid (complications, surgery)
• Positron-Emission Tomography
• Randomized Controlled Trials as Topic
• Subcutaneous Fat (metabolism)