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Glucose Metabolism Parameters and Post-Prandial GLP-1 and GLP-2 Release Largely Vary in Several Distinct Situations: a Controlled Comparison Among Individuals with Crohn’s Disease and Individuals with Obesity Before and After Bariatric Surgery

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Abstract

Background

This study aims to compare the post-prandial curves of glucose, insulin, GLP-1, and GLP-2 among individuals with Crohn’s disease (CD), obese individuals before and after bariatric surgery, and healthy controls.

Methods

This an exploratory cross-sectional study that involved five groups of patients (two groups of individuals with CD—active and inactive), bariatric patients (pre- and post-surgery, who were their own controls), and a distinct separated control group of healthy volunteers. C-reactive protein (CRP) levels and the post-prandial curves of glucose, insulin, GLP-1, and GLP-2 curves were assessed and compared.

Results

The pre-RYGB group presented significantly higher levels of CRP than the post-RYGB (p = 0.001) and the control group (p = 0.001). The inactive CD group presented a higher post-prandial GLP-1 area under the curve (AUC) than the pre-RYGB group (p = 0.009). The post-RYGB group presented significantly higher AUCs of GLP-2 than the pre-RYGB group (p < 0.0001), both inactive and active CD groups (p < 0.0001 in both situations), and the control group (p = 0.002). The pre-RYGB group presented a significantly higher AUC of glucose than the post-RYGB (p = 0.02) and both active and inactive CD groups (p = 0.019 and p = 0.046, respectively). The pre-RYGB group presented a significantly higher AUC of insulin than the control (p = 0.005) and both CD groups (p < 0.0001).

Conclusions

Obesity is associated with an inflammatory state comparable to the one observed in CD; inflammation may also be enrolled in the blockade of GLP-2. CD individuals present a more incretin-driven pattern of glucose metabolism, as a way to prevent hypoglycemia and compensate the carbohydrate malabsorption and GLP-2 blockade.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil

    Daniéla Oliveira Magro, Everton Cazzo, Carlos Augusto Real Martinez, Elinton Adami Chaim, José Carlos Pareja & Cláudio Saddy Rodrigues Coy

  2. Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, Paraná, Brazil

    Paulo Gustavo Kotze

  3. Research Laboratory of Metabolism and Diabetes (LIMED), Gastrocentro, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil

    Ana Carolina Junqueira Vasques & Bruno Geloneze

Authors
  1. Daniéla Oliveira Magro
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  2. Everton Cazzo
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  8. José Carlos Pareja
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  9. Cláudio Saddy Rodrigues Coy
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Correspondence to Everton Cazzo.

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Conflict of Interest

Paulo Gustavo Kotze is a speaker and consultant for Abbvie, Ferring, Janssen, and Takeda.

Other authors declare that they have no conflict of interest.

Statement of Informed Consent

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

Statement of Human and Animal Rights

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

Funding

This study was supported by grants from Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), protocols 2009/50430-6 and 2014/06164-8.

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Magro, D.O., Cazzo, E., Kotze, P.G. et al. Glucose Metabolism Parameters and Post-Prandial GLP-1 and GLP-2 Release Largely Vary in Several Distinct Situations: a Controlled Comparison Among Individuals with Crohn’s Disease and Individuals with Obesity Before and After Bariatric Surgery. OBES SURG 28, 378–388 (2018). https://doi.org/10.1007/s11695-017-2851-y

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