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FGF 19 and Bile Acids Increase Following Roux-en-Y Gastric Bypass but Not After Medical Management in Patients with Type 2 Diabetes

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Abstract

Background

This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment.

Methods

Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n = 15) or RYGB (n = 15).

Results

Mean HbA1c decreased from 9.7 to 6.4 % after RYGB and from 9.1 to 6.1 % in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5 ± 0.5) was less than in the IMM group (4.6 ± 0.3). After RYGB, FGF19 increased in the fasted (93 ± 15 to 152 ± 19 pg/ml; P = 0.008) and postprandial states (area under the curve (AUC), 10.8 ± 1.9 to 23.4 ± 4.1 pg × h/ml × 103; P = 0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×103, 6.63 ± 1.3 to 15.16 ± 2.56 μM × h; P = 0.003) and decreased after IMM (AUC ×103, 8.22 ± 1.24 to 5.70 ± 0.70; P = 0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r = 0.54, P = 0.04) and trended negatively with HbA1c (r = −0.44; P = 0.09); these associations were not observed after IMM.

Conclusions

BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.

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Acknowledgments

The investigators express gratitude to all study participants and recognize the contributions of the study coordinators, Joyce Schone, RD and Nyra Wimmergren, RN (University of Minnesota), Heather Bainbridge RD, CDN (Columbia University Medical Center), Avis Thomas, MS (statistician, University of Minnesota Data Coordinating Center), and Irene M. Conwell and Tiffany Thomas, Ph.D. (Columbia University Medical Center) for expert technical assistance.

Conflict of Interest

All authors have completed and submitted Disclosure of Potential Conflicts of Interest. Dr Billington reports receiving grant support from Covidien and personal support for consultancy from EnteroMedics Inc. Dr Connett reports receiving grant support from Covidien. Dr Ikramuddin serves as an advisory board member for Novo Nordisk, USGI, and Medica; consults for Metamodix Inc; and receives grant support from Covidien, EnteroMedics, and ReShape Medical. Dr Korner reports receiving institutional grant support from Covidien, travel expenses from American Board of Obesity Medicine, and personal support for serving on the Takeda Speaker Bureau and on the Scientific Advisory Board for Nutrisystem and consulting for the Office of Professional Misconduct and L.E.K Consulting.

Ethical Approval

All procedures involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

The study was supported in part by Covidien, Mansfield, MA. The sponsoring agency had no role in the collection, management, analysis, and interpretation of the study data and had no part in the preparation of the manuscript. The sponsor was allowed to review the manuscript prior to submission but had no role in the decision to submit the manuscript for publication. Additional support was received from National Institutes of Health grant DK072011 (J.K.), the National Center for Advancing Translations Sciences Grant UL1 TR000040, and discretionary funds from Columbia University Medical Center (to J.K.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Medicine, Columbia University Medical Center, 650 West 168th St, Black Building, Room 905, New York, NY, 10032, USA

    Saachi Sachdev & Judith Korner

  2. Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA

    Qi Wang & John Connett

  3. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Charles Billington

  4. Department of Surgery, Columbia University Medical Center, New York, NY, USA

    Leaque Ahmed

  5. Department of Surgery, Mount Sinai Medical Center, New York, NY, USA

    William Inabnet

  6. Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA

    Streamson Chua

  7. Department of Surgery, University of Minnesota, Minneapolis, MN, USA

    Sayeed Ikramuddin

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  1. Saachi Sachdev
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Correspondence to Judith Korner.

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Sachdev, S., Wang, Q., Billington, C. et al. FGF 19 and Bile Acids Increase Following Roux-en-Y Gastric Bypass but Not After Medical Management in Patients with Type 2 Diabetes. OBES SURG 26, 957–965 (2016). https://doi.org/10.1007/s11695-015-1834-0

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  • DOI: https://doi.org/10.1007/s11695-015-1834-0

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