Hormone changes and diabetes resolution after biliopancreatic diversion and laparoscopic sleeve gastrectomy: a comparative prospective study

Surg Obes Relat Dis. Sep-Oct 2013;9(5):667-77. doi: 10.1016/j.soard.2012.12.006. Epub 2013 Jan 13.


Background: Biliopancreatic diversion (BPD) is the most effective bariatric procedure in terms of weight loss and remission of diabetes type 2 (T2DM), but it is accompanied by nutrient deficiencies. Sleeve gastrectomy (SG) is a relatively new operation that has shown promising results concerning T2DM resolution and weight loss. The objective of this study was to evaluate and compare prospectively the effects of BPD long limb (BPD) and laparoscopic SG on fasting, and glucose-stimulated insulin, glucagon, ghrelin, peptide YY (PYY), and glucagon-like peptide-1 (GLP-1) secretion and also on remission of T2DM, hypertension, and dyslipidemia in morbidly obese patients with T2DM.

Methods: Twelve patients (body mass index [BMI] 57.6 ± 9.9 kg/m(2)) underwent BPD and 12 (BMI 43.7 ± 2.1 kg/m(2)) underwent SG. All patients had T2DM and underwent an oral glucose tolerance test (OGTT) before and 1, 3, and 12 months after surgery.

Results: BMI decreased more after BPD, but percent excess weight loss (%EWL) was similar in both groups (P = .8) and T2DM resolved in all patients at 12 months. Insulin sensitivity improved more after BPD than after SG (P = .003). Blood pressure, total and LDL cholesterol decreased only after BPD (P<.001). Triglycerides decreased after either operation, but HDL increased only after SG (P<.001). Fasting ghrelin did not change after BPD (P = .2), but decreased markedly after SG (P<.001). GLP-1 and PYY responses during OGTT were dramatically enhanced after either procedure (P = .001).

Conclusions: SG was comparable to BPD in T2DM resolution but inferior in improving dyslipidemia and blood pressure. SG and BPD enhanced markedly PYY and GLP-1 responses but only SG suppressed ghrelin levels.

Keywords: Biliopancreatic diversion; Diabetes mellitus; Dyslipidemia; GLP-1; Ghrelin; Glucagon; Hypertension; Insulin; PYY; Sleeve gastrectomy; Weight loss.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Biliopancreatic Diversion / methods*
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Dyslipidemias / prevention & control
  • Female
  • Gastrectomy / methods*
  • Ghrelin / blood
  • Glucagon / blood
  • Glucagon-Like Peptide 1 / blood
  • Glucose Tolerance Test
  • Humans
  • Hypertension / prevention & control
  • Insulin / blood
  • Laparoscopy / methods*
  • Luminescence
  • Male
  • Middle Aged
  • Obesity, Morbid / blood*
  • Obesity, Morbid / surgery*
  • Peptide YY / blood
  • Prospective Studies
  • Radioimmunoassay
  • Treatment Outcome
  • Weight Loss


  • Ghrelin
  • Insulin
  • Peptide YY
  • Glucagon-Like Peptide 1
  • Glucagon