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Is Intestinal Gluconeogenesis a Key Factor in the Early Changes in Glucose Homeostasis Following Gastric Bypass?

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Abstract

Background

In 2008, Troy et al. hypothesised that under fasting conditions, intestinal gluconeogenesis generates glucose levels in the portal vein which trigger the portal sensor to change insulin resistance and that this mechanism contributes to the effects of Roux-en-Y gastric bypass (RYGB) surgery on type 2 diabetes mellitus (T2DM). In a recent paper, Kashyap et al. (Int J Obes 34(3):426–471, 2010) cited this hypothesis as a potential explanation for the early changes in insulin sensitivity and beta cell function seen after RYGB. We proposed a study to examine this possibility.

Methods

We simultaneously sampled fasting portal venous blood and central venous blood in 28 patients (eight diabetics and 20 non-diabetics) before and again six days after RYGB surgery in morbidly obese patients, for measurement of glucose levels.

Results

We found no significant difference in the glucose levels from the two sites either before or after RYGB in diabetic patients and a small, but significant difference in the post-operative glucose levels from non-diabetic patients (4.2 vs 4.0 mM, p < 0.0001).

Conclusions

Direct simultaneous measurement of fasting glucose in portal and central venous blood before and 6 days after RYGB provides no evidence to support the hypothesis that intestinal gluconeogenesis contributes to the resolution of T2DM seen after RYGB.

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Acknowledgements

The Wellington Medical Research Foundation, New Zealand Lottery Grants Board, Health Research Council of New Zealand and the Wakefield Clinic provided contributions to salaries and consumables. They have had no role in the design and conduct of the study or interpretation of the data.

Conflict of Interest

Dr. Mark Hayes, Dr. Jonathan Foo, Mr. Vinko Besic, Dr. Yulia Tychinskaya and Professor Richard Stubbs all declare that no conflict of interest exists.

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Authors and Affiliations

  1. Wakefield Biomedical Research Unit, University of Otago, Wellington, New Zealand

    Mark Thomas Hayes, Jonathan Foo, Vinko Besic & Richard Strawson Stubbs

  2. The Wakefield Clinic, Wakefield Hospital, Wellington, New Zealand

    Jonathan Foo, Yulia Tychinskaya & Richard Strawson Stubbs

Authors
  1. Mark Thomas Hayes
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  2. Jonathan Foo
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  3. Vinko Besic
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  4. Yulia Tychinskaya
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  5. Richard Strawson Stubbs
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Correspondence to Richard Strawson Stubbs.

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Hayes, M.T., Foo, J., Besic, V. et al. Is Intestinal Gluconeogenesis a Key Factor in the Early Changes in Glucose Homeostasis Following Gastric Bypass?. OBES SURG 21, 759–762 (2011). https://doi.org/10.1007/s11695-011-0380-7

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  • DOI: https://doi.org/10.1007/s11695-011-0380-7

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