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Mechanisms of type 2 diabetes resolution after Roux-en-Y gastric bypass.
- Source :
-
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery [Surg Obes Relat Dis] 2014 Nov-Dec; Vol. 10 (6), pp. 1028-39. Date of Electronic Publication: 2014 Aug 15. - Publication Year :
- 2014
-
Abstract
- Background: Bariatric surgery is the most effective treatment for the reduction of weight and resolution of type 2 diabetes mellitus (T2 DM). The objective of this study was to longitudinally assess hormonal and tissue responses after RYGB.<br />Methods: Eight patients (5 with T2 DM) were studied before and after RYGB. A standardized test meal (STM) was administered before and at 1, 3, 6, 9, 12, and 15 months. Separately, a 2-hour hyperinsulinemic-euglycemic clamp (E-clamp) and a 2-hour hyperglycemic clamp (H-clamp) were performed before and at 1, 3, 6, and 12 months. Glucagon-like peptide-1 (GLP-1) was infused during the last hour of the H-clamp. Body composition was assessed with DXA methodology.<br />Results: Enrollment body mass index was 49±3 kg/m(2) (X±SE). STM glucose and insulin responses were normalized by 3 and 6 months. GLP-1 level increased dramatically at 1, 3, and 6 months, normalizing by 12 and 15 months. Insulin sensitivity (M of E-clamp) increased progressively at 3-12 months as fat mass decreased. The insulin response to glucose alone fell progressively over 12 months but the glucose clearance/metabolism (M of H-clamp) did not change significantly until 12 months. In response to GLP-1 infusion, insulin levels fell progressively throughout the 12 months.<br />Conclusion: The early hypersecretion of GLP-1 leads to hyperinsulinemia and early normalization of glucose levels. The GLP-1 response normalizes within 1 year after surgery. Enhanced peripheral tissue sensitivity to insulin starts at 3 months and is associated with fat mass loss. β-cell sensitivity improves at 12 months and after the loss of ≈33% of excess weight. There is a tightly controlled feedback loop between peripheral tissue sensitivity and β-cell and L-cell (GLP-1) responses.<br /> (Copyright © 2014 American Society for Bariatric Surgery. All rights reserved.)
- Subjects :
- Absorptiometry, Photon
Biomarkers blood
Blood Glucose analysis
Body Composition
Body Mass Index
C-Peptide blood
Enzyme-Linked Immunosorbent Assay
Female
Glucagon blood
Glucagon-Like Peptide 1 administration & dosage
Glucagon-Like Peptide 1 blood
Glucose Clamp Technique
Humans
Insulin blood
Male
Middle Aged
Weight Loss
Diabetes Mellitus, Type 2 prevention & control
Gastric Bypass methods
Obesity, Morbid surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1878-7533
- Volume :
- 10
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 25443077
- Full Text :
- https://doi.org/10.1016/j.soard.2014.07.011