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Lower Glycemic Fluctuations Early After Bariatric Surgery Partially Explained by Caloric Restriction

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Abstract

Background

We assessed the acute impact of laparoscopic Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) compared to caloric-matched control group without surgery on glucose excursion in obese patients with type 2 diabetes, and examined if this was mediated by changes in insulin resistance, early insulin response or glucagon-like peptide (GLP)-1 levels.

Methods

Six-day subcutaneous continuous glucose monitoring (CGM) recordings were obtained from patients beginning 3 days before GBP (n = 11), SG (n = 10) or fasting in control group (n = 10). GLP-1, insulin and glucose were measured during 75 g oral glucose tolerance testing at the start and end of each CGM.

Results

Post-operative hyperglycaemia occurred after both surgeries in the first 6 h, with a more rapid decline in glycaemia after GBP (p < 0.001). Beyond 24 h post-operatively, continuous overlapping of net glycaemia action reduced from baseline after GBP (median [interquartile range]) 1.6 [1.2–2.4] to 1.0 [0.7–1.3] and after SG 1.4 [0.9–1.8] to 0.7 [0.7–1.0]; p < 0.05), similar to controls (2.2 [1.7–2.5] to 1.3 [0.8–2.8] p < 0.05). Higher log GLP-1 increment post-oral glucose occurred after GBP (mean ± SE, 0.80 ± 0.12 vs. 0.37 ± 0.09, p < 0.05), but not after SG or control intervention. Among subgroup with baseline hyperglycaemia, a reduction in HOMA-IR followed GBP. Reduction in time and level of peak glucose and 2-h glucose occurred after both surgeries but not in controls.

Conclusions

GBP and SG have a similar acute impact on reducing glycaemia to caloric restriction; however, with a superior impact on glucose tolerance.

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Acknowledgments

We are grateful to Prof Tim Cundy for his helpful discussion and Amy Liu for her assistance in analysing subjects’ caloric intake. This study was supported by Jens Henrik Jensen Academic Fellowship and Auckland A+ research trust.

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Authors and Affiliations

  1. Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand

    S. Yip & R. Murphy

  2. Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

    M. Signal & J. G. Chase

  3. Department of Molecular Medicine & Pathology, University of Auckland, Auckland, New Zealand

    G. Smith

  4. Department of Surgery, Auckland City Hospital, Auckland, New Zealand

    G. Beban

  5. Department of Surgery, North Shore Hospital, Auckland, New Zealand

    M. Booth

  6. Department of Surgery, Middlemore Hospital, Auckland, New Zealand

    R. Babor

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  1. S. Yip
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  2. M. Signal
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  3. G. Smith
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  4. G. Beban
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  7. J. G. Chase
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  8. R. Murphy
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Corresponding author

Correspondence to R. Murphy.

Additional information

Clinical trial registry: Australian New Zealand Clinical Trials Registry (ACTRN12609000679280)

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Yip, S., Signal, M., Smith, G. et al. Lower Glycemic Fluctuations Early After Bariatric Surgery Partially Explained by Caloric Restriction. OBES SURG 24, 62–70 (2014). https://doi.org/10.1007/s11695-013-1043-7

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  • DOI: https://doi.org/10.1007/s11695-013-1043-7

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