Advertisement

Surgical Endoscopy

, Volume 28, Issue 1, pp 91–99 | Cite as

Response to glucose tolerance testing and solid high carbohydrate challenge: comparison between Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch

  • Mitchell S. Roslin
  • Yuriy Dudiy
  • Andrew BrownleeEmail author
  • Joanne Weiskopf
  • Paresh Shah
Article

Abstract

Background

Hyperinsulinemic hypoglycemia is common after Roux-en-Y gastric bypass (RYGB) and may result in weight regain. The purpose of our investigation was to compare the effect of RYGB, vertical sleeve gastrectomy (VSG), and duodenal switch (DS) on insulin and glucose response to carbohydrate challenge.

Methods

Patients meeting National Institutes of Health criteria for bariatric surgery selected their bariatric procedure after evaluation and education in this prospective nonrandomized study. Preoperatively and at 6, 9, and 12 months’ follow-up, patients underwent blood draw to determine levels of fasting glucose, fasting insulin, glycated hemoglobin (HbA1c), C-peptide, and 2-h oral glucose challenge test. Homoeostatic Model Assessment (HOMA)-IR, fasting to 1-h and 1- to 2-h ratios of glucose and insulin, were calculated. Statistical analysis was performed using ANOVA and Student’s paired t test. All procedures were performed via a laparoscopic technique at a single institution.

Results

Data from a total of 38 patients (13 RYGB, 12 VSG, 13 DS) were available for analysis. At baseline, all groups were similar; the only statistically significant difference was that DS patients had a higher preoperative weight and body mass index (BMI). All operations caused weight loss (BMI 47.7 ± 10–30.7 ± 6.4 kg/m2 in RYGB; 45.7 ± 8.5–31.1 ± 5.5 kg/m2 in VSG; 55.9 ± 11.4–27.5 ± 5.6 kg/m2 in DS), reduction of fasting glucose, and improved insulin sensitivity. RYGB patients had a rapid rise in glucose with an accompanying rise in 1-h insulin to a level that exceeded preoperative levels. This was followed by a rapid decrease in glucose level. In comparison, DS patients had a lower increase in glucose and 1-h insulin, and the lowest HbA1c. These differences were statistically significant at various data points. For VSG, the results were intermediary.

Conclusions

Compared to gastric bypass, DS results in greater weight loss and improves insulin sensitivity and glucose homeostasis without causing a hyperinsulinemic response. Because the response to challenge after VSG is intermediary, pyloric preservation alone cannot account for this difference.

Keywords

Bariatric Weight loss Sleeve gastrectomy Digestive Duodenal switch Gastric bypass 

Notes

Disclosures

This study was supported by a research Grant from Covidien. Dr. Roslin is an educational consultant for Johnson & Johnson and Covidien. He is also on the scientific advisory board for Surgiquest and Valentx. Dr. Shah is on the scientific advisory board of Stryker and Transenterix and is a consultant for Johnson & Johnson, Olympus, and Ethicon Endo-surgery. Drs. Brownlee and Dudiy and Ms. Weiskopf have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Sjostrom L (2013) Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med 273(3):219–234PubMedCrossRefGoogle Scholar
  2. 2.
    Cui Y, Elahi D, Andersen DK (2011) Advances in the etiology and management of hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass. J Gastrointest Surg 15(10):1879–1888PubMedCrossRefGoogle Scholar
  3. 3.
    Rabiee A, Magruder JT, Salas-Carrillo R, Carlson O, Egan JM, Askin FB, Elahi D, Andersen DK (2011) Hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass: unraveling the role of gut hormonal and pancreatic endocrine dysfunction. J Surg Res 167(2):199–205PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Roslin MS, Oren JH, Polan BN, Damani T, Brauner R, Shah PC (2013) Abnormal glucose tolerance testing after gastric bypass. Surg Obes Relat Dis 9(1):26–31PubMedCrossRefGoogle Scholar
  5. 5.
    Mathavan VK, Arregui M, Davis C, Singh K, Patel A, Meacham J (2010) Management of postgastric bypass noninsulinoma pancreatogenous hypoglycemia. Surg Endosc 24(10):2547–2555PubMedCrossRefGoogle Scholar
  6. 6.
    Service GJ, Thompson GB, Service FJ, Andrews JC, Collazo-Clavell ML, Lloyd RV (2005) Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med 353(3):249–254PubMedCrossRefGoogle Scholar
  7. 7.
    Lustig RH (2013) Fructose: it’s “alcohol without the buzz”. Adv Nutr 4(2):226–235PubMedCrossRefGoogle Scholar
  8. 8.
    Ajala O, English P, Pinkney J (2013) Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr 97(3):505–516PubMedCrossRefGoogle Scholar
  9. 9.
    Halperin F, Patti ME, Skow M, Bajwa M, Goldfine AB (2011) Continuous glucose monitoring for evaluation of glycemic excursions after gastric bypass. J Obes 2011:869536PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Hedberg J, Sundbom M (2013) Superior weight loss and lower HbA1c 3 years after duodenal switch compared with Roux-en-Y gastric bypass—a randomized controlled trial. Surg Obes Relat Dis 8(3):338–343CrossRefGoogle Scholar
  11. 11.
    Rawlins L, Rawlins MP, Brown CC, Schumacher DL (2013) Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis 9(1):21–25PubMedCrossRefGoogle Scholar
  12. 12.
    Dorman RB, Rasmus NF, al-Haddad BJ, Serrot FJ, Slusarek BM, Sampson BK, Buchwald H, Leslie DB, Ikramuddin S (2012) Benefits and complications of the duodenal switch/biliopancreatic diversion compared to the Roux-en-Y gastric bypass. Surgery 152(4):758–765PubMedCrossRefGoogle Scholar
  13. 13.
    Salinari S, Bertuzzi A, Guidone C, Previti E, Rubino F, Mingrone G (2013) Insulin sensitivity and secretion changes after gastric bypass in normotolerant and diabetic obese subjects. Ann Surg 257(3):462–468PubMedCrossRefGoogle Scholar
  14. 14.
    McLaughlin T, Peck M, Holst J, Deacon C (2010) Reversible hyperinsulinemic hypoglycemia after gastric bypass: a consequence of altered nutrient delivery. J Clin Endocrinol Metab 95(4):1851–1855PubMedCrossRefGoogle Scholar
  15. 15.
    Mallory GN, Macgregor AM, Rand CS (1996) The influence of dumping on weight loss after gastric restrictive surgery for morbid obesity. Obes Surg 6(6):474–478PubMedCrossRefGoogle Scholar
  16. 16.
    Frenken M, Cho EY, Karcz WK, Grueneberger J, Kuesters S (2011) Improvement of type 2 diabetes mellitus in obese and non-obese patients after the duodenal switch operation. J Obes 2011:860169PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366(17):1567–1576PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Mingrone G, Castagneto-Gissey L (2009) Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery. Diabetes Metab 35(6 Pt 2):518–523PubMedCrossRefGoogle Scholar
  19. 19.
    Yu H, Zheng X, Zhang Z (2013) Mechanism of Roux-en-Y gastric bypass treatment for type 2 diabetes in rats. J Gastrointest Surg 17(6):1073–1083PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Johansson HE, Haenni A, Karlsson FA, Edén-Engström B, Ohrvall M, Sundbom M, Zethelius B (2010) Bileopancreatic diversion with duodenal switch lowers both early and late phases of glucose, insulin and proinsulin responses after meal. Obes Surg 20(5):549–558PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Mitchell S. Roslin
    • 1
    • 2
  • Yuriy Dudiy
    • 1
  • Andrew Brownlee
    • 1
    Email author
  • Joanne Weiskopf
    • 1
  • Paresh Shah
    • 1
  1. 1.Lenox Hill HospitalNew YorkUSA
  2. 2.Northern Westchester Hospital CenterMt. KiscoUSA

Personalised recommendations