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Insulin cells and surgical success

Insulin cells determine bariatric surgery success rate

This new study reveals that the decisive factor is in fact the capacity to produce insulin

Danish researchers have found that the ability to produce insulin is pivotal to the success of weight loss surgery in patients with type 2-diabetes. The study authors claim the research provides crucial indicators for advising patients and determining which patients will benefit from surgery. The study, ‘Functional adaptation of the human β-cells after frequent exposure to noradrenaline’, was published in the Journal of Physiology.

"Our study shows that the patients' ability to produce insulin is decisive for whether or not the procedure eliminates diabetes,” said Professor Flemming Dela from the Center for Healthy Aging at the University of Copenhagen, Denmark. “Measuring the insulin cells' performance before surgery can thus provide us with a much better basis from which to predict who will actually benefit from the surgery. This type of measurement is not currently included in doctors' assessments."

Flemming Dela

In the study, researchers measured the insulin-producing cells' ability to produce insulin twice prior to and twice following the surgery. Four months after the surgery, 57% of the patients with the best insulin-producing cells prior to the procedure no longer had diabetes, while there was no change in the group of patients with poor insulin-producing cells. Eighteen months after the surgery, 71% of those in the group with the best insulin-producing cells no longer had diabetes as opposed to 38% in the group with the poorest insulin-producing cells.

Dala said that bariatric surgery constitutes a substantial surgical procedure and the doctors' ability to predict which patients will actually benefit from a weight loss surgery is thus important, not only to the patients but also to the economy. Researchers have long known that the weight loss that accompanies a weight loss surgery also improves the effectiveness of insulin. Up until now, they believed that improved insulin sensitivity was a prerequisite for the elimination of diabetes. However, this new study reveals that the decisive factor is in fact the capacity to produce insulin.

"The ability to produce sufficient amounts of insulin is inversely related to duration of the disease. The longer the patient has had diabetes, the poorer the ability to produce insulin,” added Dala. “Thus, these new results also point to the importance of undergoing an operating at an early stage, before the patients lose their ability to produce insulin.”

However, more studies are needed before the test can be included in the preliminary examinations of patients awaiting a weight loss surgery and help determine the amount of insulin needed to ensure a successful procedure. Measuring insulin is not standardised across laboratories, and this is a prerequisite for the test to be included in preliminary examinations.

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