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BPD vs RYGB

Biliopancreatic diversion improves insulin sensitivity vs RYGB

Patients who received biliopancreatic diversion surgery were found to be more sensitive to insulin

Some studies have demonstrated that biliopancreatic diversion has been better at reducing diabetes compared to Roux-en-Y gastric bypass, because it typically causes greater weight loss. However, small study by researchers at Washington University School of Medicine in St Louis have reported that biliopancreatic diversion appears to be more effective at eliminating diabetes not just because of greater weight loss but because the procedure itself seems to make patients more sensitive to insulin.

The study, ‘Biliopancreatic Diversion Induces Greater Metabolic Improvement Than Roux-en-Y Gastric Bypass’, published in the journal Cell Metabolism, they compared the effects of the two surgeries on insulin and glucose sensitivity in patients who, after their operations, lost 20 percent of their body weight.

Dr Samuel Klein

"Our results help explain the high rate of diabetes remission in patients who have biliopancreatic diversion surgery," said senior author, Dr Samuel Klein, director of Washington University's Center for Human Nutrition. "These data suggest that we should take a closer look to see whether it might be a better option for some bariatric surgery patients."

The gastric bypass group in the study had average BMI48, compared to an average BMI56 in the biliopancreatic diversion group.The surgeries were performed at Catholic University in Rome. The operations were done overseas because biliopancreatic diversion is more commonly performed in Italy. In the US, some 228,000 bariatric surgical procedures were performed in 2017. Fewer than 3 percent were biliopancreatic diversion.

After surgery and a 20 percent loss of body weight, the study patients' metabolic reactions to meals were measured, with close attention paid to their glucose levels, sensitivity to insulin and how much insulin they secreted after eating. The researchers found no difference in the benefit of surgery-induced weight loss to patients' pancreatic function, in terms of insulin secretion, but patients who received biliopancreatic diversion surgery were found to be more sensitive to insulin.

“The rate of appearance of ingested glucose into the circulation was much slower, and the postprandial increases in plasma glucose and insulin concentrations were markedly blunted after BPD compared to after RYGB. Insulin sensitivity, assessed as glucose disposal rate during insulin infusion, was ∼45% greater after BPD than RYGB, whereas β cell function was not different between groups,” The researchers write. “These results demonstrate that compared with matched-percentage weight loss induced by RYGB, BPD has unique beneficial effects on glycaemic control, manifested by slower postprandial glucose absorption, blunted postprandial plasma glucose and insulin excursions, and greater improvement in insulin sensitivity.”

Klein noted that while the patients had obesity, none had been diagnosed with type 2 diabetes. The study was structured that way because the researchers wanted to independently measure the insulin sensitivity after a meal, without potential complications caused by diabetes medications.

"This study demonstrates that biliopancreatic diversion has unique, beneficial effects on insulin action, independent of any weight loss," he said. "This study demonstrates additional metabolic benefits from biliopancreatic diversion, compared to Roux-en-Y gastric bypass," he said.

As to whether that surgery should be preferred because of these findings, Klein said that's less clear. The main consideration, he said, should be patient safety.

"But the type of bariatric surgery performed on any individual patient depends on many considerations, including an assessment of the effectiveness and safety of the procedure, patient preference, and the surgeon's experience."

Klein, the William H Danforth Professor of Medicine and Nutritional Science and chief of the Division of Geriatrics and Nutritional Science, added that Roux-en-Y gastric bypass provides considerable benefits in helping people lose weight and in treating type 2 diabetes but does not have the weight-loss-independent benefits on insulin sensitivity of biliopancreatic diversion.

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