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Differential Acute Impacts of Sleeve Gastrectomy, Roux-en-Y Gastric Bypass Surgery and Matched Caloric Restriction Diet on Insulin Secretion, Insulin Effectiveness and Non-Esterified Fatty Acid Levels Among Patients with Type 2 Diabetes

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Abstract

Background

Bariatric surgery is an increasingly common option for control of type 2 diabetes (T2D) and obesity. Mechanisms underlying rapid improvement of T2D after different types of bariatric surgery are not clear. Caloric deprivation and altered levels of non-esterified fatty acid (NEFA) have been proposed. This study examines how sleeve gastrectomy (SG), Roux-en-Y gastric bypass (GBP) or matched hypocaloric diet (DT) achieves improvements in T2D by characterising components of the glucose metabolism and NEFA levels before and 3 days after each intervention.

Methods

Plasma samples at five time points during oral glucose tolerance test (OGTT) from subjects with T2D undergoing GBP (N = 11) or SG (N = 12) were analysed for C-peptide, insulin and glucose before surgery and 3-day post-intervention or after DT (N = 5). Fasting palmitic, linoleic, oleic and stearic acid were measured. C-peptide measurements were used to model insulin secretion rate (ISR) using deconvolution.

Results

Subjects who underwent GBP surgery experienced the greatest improvement in glycaemia (median reduction in blood glucose (BG) from basal by 29 % [IQR −57, −18]) and the greatest reduction in all NEFA measured. SG achieved improvement in glycaemia with lower ISR and reduction in all but palmitoleic acid. DT subjects achieved improvement in glycaemia with an increase in ISR, 105 % [IQR, 20, 220] and stearic acid.

Conclusions

GBP, SG and DT each improve glucose metabolism through different effects on pancreatic beta cell function, insulin sensitivity and free fatty acids.

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References

  1. Kashyap SR et al. Bariatric surgery for type 2 diabetes: weighing the impact for obese patients. Cleve Clin J Med. 2010;77(7):468–76.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Buchwald H et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–U81.

    Article  PubMed  Google Scholar 

  3. Pories WJ et al. Who would have thought it—an operation proves to be the most effective therapy for adult-onset diabetes-mellitus. Ann Surg. 1995;222(3):339–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Isbell JM et al. The importance of caloric restriction in the early improvements in insulin sensitivity after Roux-en-Y gastric bypass surgery. Diabetes Care. 2010;33(7):1438–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kashyap SR 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. 2010;34(3):462–71.

    Article  CAS  Google Scholar 

  6. Bayham BE et al. Early resolution of type 2 diabetes seen after Roux-en-Y gastric bypass and vertical sleeve gastrectomy. Diabetes Technol Ther. 2012;14(1):30–4.

    Article  PubMed  Google Scholar 

  7. Ramon JM et al. Effect of Roux-en-Y gastric bypass vs sleeve gastrectomy on glucose and gut hormones: a prospective randomised trial. J Gastrointest Surg. 2012;16(6):1116–22.

    Article  PubMed  Google Scholar 

  8. Henry RR, Scheaffer L, Olefsky JM. Glycemic effects of intensive caloric restriction and isocaloric refeeding in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab. 1985;61(5):917–25.

    Article  CAS  PubMed  Google Scholar 

  9. Lim EL et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54(10):2506–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Salinari S et al. Twenty-four hour insulin secretion and beta cell NEFA oxidation in type 2 diabetic, morbidly obese patients before and after bariatric surgery. Diabetologia. 2008;51(7):1276–84.

    Article  CAS  PubMed  Google Scholar 

  11. Reaven GM et al. Measurement of plasma-glucose, free fatty-acid, lactate, and insulin for 24-H in patients with NIDDM. Diabetes. 1988;37(8):1020–4.

    Article  CAS  PubMed  Google Scholar 

  12. Yue KT et al. Effect of glucose on plasma concentrations of individual non-esterified fatty acids of non-diabetic and insulin-independent diabetic men. Postgrad Med J. 1981;57(672):622–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Schaffer JE. Lipotoxicity: when tissues overeat. Curr Opin Lipidol. 2003;14(3):281–7.

    Article  CAS  PubMed  Google Scholar 

  14. Unger RH. Lipotoxicity in the pathogenesis of obesity-dependent NIDDM—genetic and clinical implications. Diabetes. 1995;44(8):863–70.

    Article  CAS  PubMed  Google Scholar 

  15. McGarry JD, Dobbins RL. Fatty acids, lipotoxicity and insulin secretion. Diabetologia. 1999;42(2):128–38.

    Article  CAS  PubMed  Google Scholar 

  16. Sako Y, Grill VE. A 48-hour lipid infusion in the rat time-dependently inhibits glucose-induced insulin-secretion and B-cell oxidation through a process likely coupled to fatty-acid oxidation. Endocrinology. 1990;127(4):1580–9.

    Article  CAS  PubMed  Google Scholar 

  17. Boden G. Role of fatty acids in the pathogenesis of insulin resistance and NIDDM. Diabetes. 1997;46(1):3–10.

    Article  CAS  PubMed  Google Scholar 

  18. Shulman GI. Cellular mechanisms of insulin resistance. J Clin Investig. 2000;106(2):171–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Yip S, Plank LD, Murphy R. Gastric bypass and sleeve gastrectomy for type 2 diabetes: a systematic review and meta-analysis of outcomes. Obes Surg. 2013;23(12):1994–2003.

    Article  PubMed  Google Scholar 

  20. Bierman EL, Schwartz IL, Dole VP. Action of insulin on release of fatty acids from tissue stores. Am J Physiol. 1957;191(2):359–62.

    CAS  PubMed  Google Scholar 

  21. Hirsch J, Goldrick RB. Serial studies on the metabolism of human adipose tissue. I. Lipogenesis and free fatty acid uptake and release in small aspirated samples of subcutaneous fat. J Clin Invest. 1964;43:1776–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Gray DS et al. Changes in individual plasma free fatty acids in obese females during fasting and refeeding. Int J Obes. 1991;15(2):163–8.

    CAS  PubMed  Google Scholar 

  23. Van Cauter E et al. Estimation of insulin secretion rates from C-peptide levels. Comparison of individual and standard kinetic parameters for C-peptide clearance. Diabetes. 1992;41(3):368–77.

    Article  PubMed  Google Scholar 

  24. Lee WJ et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146(2):143–8.

    Article  PubMed  Google Scholar 

  25. Schauer PR et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care. 2002;25(2):358–63.

    Article  PubMed  Google Scholar 

  27. Ballantyne GH et al. Short-term changes in insulin resistance following weight loss surgery for morbid obesity: laparoscopic adjustable gastric banding versus laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2006;16(9):1189–97.

    Article  CAS  PubMed  Google Scholar 

  28. Camastra S et al. Beta-cell function in severely obese type 2 diabetic patients: long-term effects of bariatric surgery. Diabetes Care. 2007;30(4):1002–4.

    Article  CAS  PubMed  Google Scholar 

  29. Mari A et al. Restoration of normal glucose tolerance in severely obese patients after bilio-pancreatic diversion: role of insulin sensitivity and beta cell function. Diabetologia. 2006;49(9):2136–43.

    Article  CAS  PubMed  Google Scholar 

  30. Ferrannini E, Mingrone G. Impact of different bariatric surgical procedures on insulin action and beta-cell function in type 2 diabetes. Diabetes Care. 2009;32(3):514–20.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Yip S et al. Lower glycemic fluctuations early after bariatric surgery partially explained by caloric restriction. Obes Surg. 2014;24(1):62–70.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We acknowledge Dr Shelley Yip for her assistance with this study.

Author information

Authors and Affiliations

  1. Department of Mechanical Engineering, University of Canterbury, Private Bag 8140, Christchurch, New Zealand

    Felicity Thomas & J. Geoffrey Chase

  2. Department of Pharmacology, UNSW Australia, Kensington, 2033, Sydney, Australia

    Greg C. Smith

  3. School of Applied Sciences and School of Interprofessional Health Studies, Faculty of Health and Environmental Sciences and Institute of Biomedical Technology, Auckland University of Technology, Private Bag 92006, Box A-25, Auckland, 1142, New Zealand

    Jun Lu

  4. Department of General Surgery, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, 1640, New Zealand

    Richard Babor

  5. Department of General Surgery, Waitemata District Hospital Board, Shakespeare Rd, Takapuna, Auckland, New Zealand

    Michael Booth

  6. Department of General Surgery, Auckland City Hospital, Park Rd, Grafton, Auckland, 1023, New Zealand

    Grant Beban

  7. Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand

    Rinki Murphy

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  1. Felicity Thomas
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Corresponding author

Correspondence to Felicity Thomas.

Ethics declarations

This study was approved by local ethics committee (Northern X Regional ethics committee), and all patients gave informed written consent.

Conflict of Interest

The authors declare that they have no conflict of interest.

A Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Financial Support

This study was funded by the A+ research trust and Jens Henrik Jensen fund.

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Thomas, F., Smith, G.C., Lu, J. et al. Differential Acute Impacts of Sleeve Gastrectomy, Roux-en-Y Gastric Bypass Surgery and Matched Caloric Restriction Diet on Insulin Secretion, Insulin Effectiveness and Non-Esterified Fatty Acid Levels Among Patients with Type 2 Diabetes. OBES SURG 26, 1924–1931 (2016). https://doi.org/10.1007/s11695-015-2038-3

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  • DOI: https://doi.org/10.1007/s11695-015-2038-3

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