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No Islet Cell Hyperfunction, but Altered Gut-Islet Regulation and Postprandial Hypoglycemia in Glucose-Tolerant Patients 3 Years After Gastric Bypass Surgery

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Abstract

Postprandial hyperinsulinemia characterizes Roux-en-Y gastric bypass (RYGB) and sometimes leads to reactive hypoglycemia. We prospectively evaluated changes in beta cell function in seven RYGB-operated patients with a median follow-up of 2.9 years with hyperglycemic clamps and oral glucose tolerance tests (OGTTs). Three years after RYGB, weight loss was 26 % and insulin sensitivity had improved. Insulin secretion during clamp experiments was largely unchanged compared to before surgery. In contrast, insulin secretion in response to the OGTTs doubled when evaluated by the disposition index and 2-h plasma glucose declined to a mean of 3.3 ± 0.3 mmol/l postoperatively. Our findings indicate that intrinsic beta cell function remains unchanged in glucose-tolerant patients even years after RYGB, while altered gut-islet regulation drive risk of postprandial hyperinsulinemic hypoglycemia.

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Acknowledgments

The authors are grateful to Alis Andersen (Hvidovre Hospital, Denmark) for technical assistance.

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Authors and Affiliations

  1. Department of Endocrinology, Hvidovre Hospital, Kettegaard Allé 30, DK-2650, Hvidovre, Denmark

    Carsten Dirksen, Aleksander Eiken, Kirstine N. Bojsen-Møller, Maria S Svane, Christoffer Martinussen, Nils B. Jørgensen & Sten Madsbad

  2. NNF Center for Basic Metabolic Research, The Panum Institute, University of Copenhagen, DK-2200, Copenhagen N, Denmark

    Carsten Dirksen, Aleksander Eiken, Kirstine N. Bojsen-Møller, Maria S Svane, Christoffer Martinussen, Nils B. Jørgensen & Jens J. Holst

  3. Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, DK-2200, Copenhagen N, Denmark

    Jens J. Holst

Authors
  1. Carsten Dirksen
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  2. Aleksander Eiken
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  3. Kirstine N. Bojsen-Møller
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  4. Maria S Svane
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  5. Christoffer Martinussen
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  6. Nils B. Jørgensen
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  7. Jens J. Holst
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  8. Sten Madsbad
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Corresponding author

Correspondence to Carsten Dirksen.

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Funding

The study was funded by Hvidovre Hospital (Denmark), the Danish Ministry of Science, Technology and Innovation through the UNIK project at the University of Copenhagen (Denmark), the Danish Council for Independent Research Medical Sciences (FSS), the Danish Diabetes Association, the Novo Nordisk Foundation, and the Strategic Counsel for the Capital Area of Copenhagen (Denmark).

Conflict of Interest

CD has received a speaker honorarium from Eli Lilly. JJH has received grants from Novartis and Merck and is an advisory board member/consultant for GlaxoSmithKline, Novo Nordisk, Zealand Pharmaceuticals, AstraZeneca, Sanofi, MSD, Intarcia, and Hamni. AE, KBM, MS, CM, NBJ, and SM declare that they have no conflict of interest associated with this manuscript.

Ethical Approval

The study conforms with the Declaration of Helsinki II and was approved by the Municipal Ethical Committee of Copenhagen (H-2-2014-011) and the Danish Data Protection Agency, and was registered at clinicaltrials.gov (NCT02161666).

Informed Consent

Written informed consent was obtained from all participants in the study.

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Dirksen, C., Eiken, A., Bojsen-Møller, K.N. et al. No Islet Cell Hyperfunction, but Altered Gut-Islet Regulation and Postprandial Hypoglycemia in Glucose-Tolerant Patients 3 Years After Gastric Bypass Surgery. OBES SURG 26, 2263–2267 (2016). https://doi.org/10.1007/s11695-016-2197-x

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  • DOI: https://doi.org/10.1007/s11695-016-2197-x

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