Assessment of the Dynamic Insulin Secretion and Sensitivity Test
(DISST) Pre and Post Gastric bypass Surgery
John Wilson
1
Department of Medicine, University of Otago Wellington, Wellington, New
Zealand
,
Paul Docherty
2
Centre for Bioengineering, University of Canterbury, Christchurch, New
Zealand
,
Richard Stubbs
3
P3 Research Limited, Wellington, New Zealand
,
J Geoffrey Chase
2
Centre for Bioengineering, University of Canterbury, Christchurch, New
Zealand
,
Jeremy Krebs
1
Department of Medicine, University of Otago Wellington, Wellington, New
Zealand
› InstitutsangabenFunding
JW received salary funding from a New Zealand Diabetes Foundation Fellowship. Grant in aid from Wellington Medical Research
Foundation for funding of Glucose analyser and sample analysis.
Objective To compare the dynamic insulin secretion and sensitivity
test (DISST) with the euglycaemic clamp in individuals undergoing open
Roux-en-Y gastric bypass (RYGB) surgery prior-to and one month after
surgery.
Methods Insulin sensitivity in individuals with obesity undergoing
RYGB was studied with DISST and a euglycaemic hyperinsulinaemic clamp.
Results Eleven participants, including nine females, mean(SD) age
51.2 (12.1) yrs, with a preoperative BMI of 48.7(9.5)kg/m2
were studied. Weight reduced from a mean (SD) of 133.8 (29.8) kg to
123.8 (28.9) kg post-surgery (p<0.001). The mean (SD) insulin
sensitivity index (ISI-DISST) was
3.07×10−4 (2.18) L.pmol−1.min−1
preoperatively and 2.36
×10−4 (0.78)L.pmol−1.min−1
postoperatively (p=0.37). The mean(SD) clamp ISI was 2.14
×10−2 (1.80) mg.L.kg−1.min−1.pmol−1
and
2.00×10−2.(0.76) mg.L.kg−1.min−1.pmol−1
postoperatively (p=0.86). Correlation between ISI-DISST and
ISI-Clamp preoperatively was r=0.81(95%CI 0.37-0.95) and
post-operatively r=0.47(95%CI 0-0.88). Bland-Altman analysis
demonstrates systematic bias between the two tests, where DISST
underestimated insulin sensitivity compared with the clamp by
0.96×10-2.mg.L.kg−1.min−1.pmol−1
(95%CI -2.24 to 0.32).
Conclusions There was a strong correlation between DISST and the
clamp preoperatively and DISST can be used to estimate insulin sensitivity
in individuals with morbid obesity. After RYGB surgery, DISST had a weaker
correlation with the clamp suggesting the fundamental physiological
determinants of insulin sensitivity being measured by each method change in
different ways with changes in glucose homeostasis following RYGB
surgery.
Key words
dynamic insulin secretion and sensitivity test -
Roux-en-Y gastric bypass -
obesity -
weight loss -
Type 2 Diabetes
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