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Short- and Long-Term Hormonal and Metabolic Consequences of Reversing Gastric Bypass to Normal Anatomy in a Type 2 Diabetes Patient

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Abstract

Gastric bypass (GBP) results in rapid type 2 diabetes (T2D) remission in most cases. Consequences of GBP reversal are unknown. A GBP-operated T2D patient was given mixed-meal tests before (MMTpre), 2 months (MMT2-M) and 12 months (MMT12-M) after GBP reversal. Glucose, hormones and metabolite profiles were assessed. MMT2-M displayed slightly lower glucose levels; MMT12-M displayed higher glucose and insulin levels, indicating deteriorating glycaemia. Homeostasis model assessment (HOMA)-β was higher at MMT2-M, but reduced at MMT12-M. Matsuda index revealed slightly reduced insulin sensitivity at MMT2-M, which deteriorated further at MMT12-M. Markers for metabolic stress and insulin resistance were elevated at MMT12-M. Gastric inhibitory polypeptide (GIP) levels were increased at MMT2-M and decreased at MMT12-M. Glucagon-like peptide-1 (GLP-1) decreased at MMT2-M and further decreased at MMT12-M. In conclusion, in this patient, GBP reversal provoked deteriorating glycaemia and long-term development of insulin resistance.

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Acknowledgments

This work was supported by grants from the Swedish Research Council including project grant (LG: Dnr. 521-2007-4037, NW: Dnr. 2008–4216 and 521-2012-2119, strategic research area grant (EXODIAB: Dnr. 2009–1039) and Linnaeus grant (LUDC): Dnr. 349-2008-6589), an Advanced Research Grant from the European Research Council for LG (GA 269045) as well as equipment grants from Wallenberg (KAW 2009–0243) and Lundberg Foundation (grant nr. 359). In addition, the project was funded by the EU grant ENGAGE, The Albert Påhlsson Foundation, The Swedish Diabetes Foundation, ALF and the medical faculty at Lund University.

Conflict of Interest

Dr. Wierup, Dr. Lindqvist, Dr. Spégel, Dr. Groop, Dr. Hedenbro and Dr. Ekelund declare no conflict of interest.

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Authors and Affiliations

  1. Clinical Research Centre, Neuroendocrine Cell Biology, Department of Clinical Sciences in Malmö, Lund University Diabetes Centre, Skåne University Hospital, Jan Waldenströms gata 35, Malmö, Sweden

    Nils Wierup, Andreas Lindqvist, Peter Spégel & Leif Groop

  2. Clinical Sciences Lund, Surgery, Lund University, Lund, Sweden

    Jan Hedenbro & Mikael Ekelund

  3. Aleris Obesity, Lund, Sweden

    Jan Hedenbro

  4. Department of Surgery, Skåne University Hospital, Lund, Sweden

    Mikael Ekelund

Authors
  1. Nils Wierup
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  2. Andreas Lindqvist
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  3. Peter Spégel
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  4. Leif Groop
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  5. Jan Hedenbro
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  6. Mikael Ekelund
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Correspondence to Nils Wierup.

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Wierup, N., Lindqvist, A., Spégel, P. et al. Short- and Long-Term Hormonal and Metabolic Consequences of Reversing Gastric Bypass to Normal Anatomy in a Type 2 Diabetes Patient. OBES SURG 25, 180–185 (2015). https://doi.org/10.1007/s11695-014-1459-8

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  • DOI: https://doi.org/10.1007/s11695-014-1459-8

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