Date: 11 May 2011
Early Improvement in Glycemic Control After Bariatric Surgery and Its Relationships with Insulin, GLP-1, and Glucagon Secretion in Type 2 Diabetic Patients
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The surgical treatment of obesity ameliorates metabolic abnormalities in patients with type 2 diabetes. The objective of this study was to evaluate the early effects of Roux-en-Y gastric bypass (RYGB) on metabolic and hormonal parameters in patients with type 2 diabetes (T2DM).
Ten patients with T2DM (BMI, 39.7 ± 1.9) were evaluated before and 7, 30, and 90 days after RYGB. A meal test was performed, and plasma insulin, glucose, glucagon, and glucagon-like-peptide 1 (GLP-1) levels were measured at fasting and postprandially.
Seven days after RYGB, a significant reduction was observed in HOMA-IR index from 7.8 ± 5.5 to 2.6 ± 1.7; p < 0.05 was associated with a nonsignificant reduction in body weight. The insulin and GLP-1 curves began to show a peak at 30 min after food ingestion, while there was a progressive decrease in glucagon and blood glucose levels throughout the meal test. Thirty and 90 days after RYGB, along with progressive weight loss, blood glucose and hormonal changes remained in the same direction and became more expressive with the post-meal insulin curve suggesting recovery of the first phase of insulin secretion and with the increase in insulinogenic index, denoting improvement in β-cell function. Furthermore, a positive correlation was found between changes in GLP-1 and insulin levels measured at 30 min after meal (r = 0.6; p = 0.000).
Our data suggest that the RYGB surgery, beyond weight loss, induces early beneficial hormonal changes which favor glycemic control in type 2 diabetes.
Pories WJ, MacDonald KG, Morgan EJ, et al. Surgical treatment of obesity and its effect on diabetes: 10-y follow-up. Am J Nutr. 1992;55(2 Suppl):582S–5S.
Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84.PubMed
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. 2004;292(14):1724–37.
Kashyap SR, Daud S, Kelly KR, et al. Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes. Int J Obes (Lond). 2009;34(3):462–71.CrossRef
Holdstock C, Zethelius B, Sundbom M, et al. Postprandial changes in gut regulatory peptides in gastric bypass patients. Int J Obes. 2008;32(11):1640–6.CrossRef
Boden G. Free fatty acids—the link between obesity and insulin resistance. Endocr Pract. 2001;7(1):44–51.PubMed
Manfredini G, Ermini M, Scops L, et al. Internal biliary diversion improves glucose tolerance in the rat. Am J Physiol Gastrointest Liver Physiol. 1985;249:G519–27.
Furet JP, Kong LC, Tap J, et al. Differential adaptation of human gut microbiota to bariatric surgery-induced weight loss: links with metabolic and low-grade inflammation markers. Diabetes. 2010;59(12):3049–5.CrossRef
- Early Improvement in Glycemic Control After Bariatric Surgery and Its Relationships with Insulin, GLP-1, and Glucagon Secretion in Type 2 Diabetic Patients
Volume 21, Issue 7 , pp 896-901
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- RY gastric bypass
- Type 2 diabetes
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo, Rua Leandro Dupret 365, CEP 04025011, Vila Clementino, São Paulo, Brazil
- 2. Department of Surgery, Division of Gastroenterology, Universidade Federal São Paulo, Vila Clementino, São Paulo, Brazil
- 3. Department of Medicine, Division of Endocrinology, Universidade de Campinas, Campinas, São Paulo, Brazil