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A Meta-Analysis of GLP-1 After Roux-En-Y Gastric Bypass: Impact of Surgical Technique and Measurement Strategy

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Abstract

Background

Roux-en-Y gastric bypass (RYGB) is an effective treatment for diabetes. Glucagon-like peptide-1 (GLP-1) is a gut hormone that is important to glucose homeostasis.

Objective

This study aimed to assess GLP-1 level and its predictors after RYGB.

Methods

The study design was a meta-analysis. The data sources were MEDLINE, EMBASE, Web of Science, and the Cochrane Databases. The study selection composed of studies with pre- and post-RYGB levels. The main outcomes were as follows: Primary outcome was the change in postprandial GLP-1 levels after RYGB. Secondary outcomes included the changes in fasting glucose, fasting insulin, and fasting GLP-1 levels after RYGB. Meta-regression to determine predictors of changes in GLP-1 levels was performed. Outcomes were reported using Hedge’s g.

Results

Twenty-four studies with 368 patients were included. Postprandial GLP-1 levels increased after RYGB (Hedge’s g = 1.29, p < 0.0001), while fasting GLP-1 did not change (p = 0.23). Peak postprandial GLP-1 levels gave the most consistent results (I 2 = 9.11). Fasting glucose and insulin levels decreased after RYGB (p < 0.0001).

Roux limb length was a significant predictor for amount of GLP-1 increase (β = − 0.01, p = 0.02). Diabetes status, amount of weight loss, length of biliopancreatic limb, and time of measurement were not significant predictors (p > 0.05).

Conclusion

Postprandial GLP-1 levels increase after RYGB, while fasting levels remain unchanged. Shorter Roux limb length is associated with greater increase in postprandial GLP-1, which may lead to better glycemic control in this population.

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Abbreviations

RYGB:

Roux-En-Y Gastric Bypass

GLP-1:

Glucagon-Like Peptide-1

BMI:

Body Mass Index

NAFLD:

Non-alcoholic Fatty Liver Disease

US:

United States

SOS:

Swedish Obese Subjects

T2DM:

Type 2 Diabetes Mellitus

STAMPEDE:

Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently

AUC:

Area Under The Curve

OGTT:

Oral Glucose Tolerance Test

ROBINS-I:

Risk Of Bias In Non-Randomized Studies—Of Interventions

NOS:

Newcastle-Ottawa Quality Assessment Scale

CI:

Confidence Interval

RCT:

Randomized Controlled Trial

FXR:

Farnesoid X Receptor

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Pichamol Jirapinyo, David X. Jin, Taha Qazi & Christopher C. Thompson

  2. Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA

    Nitin Mishra

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  1. Pichamol Jirapinyo
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  2. David X. Jin
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Correspondence to Christopher C. Thompson.

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Jirapinyo, P., Jin, D.X., Qazi, T. et al. A Meta-Analysis of GLP-1 After Roux-En-Y Gastric Bypass: Impact of Surgical Technique and Measurement Strategy. OBES SURG 28, 615–626 (2018). https://doi.org/10.1007/s11695-017-2913-1

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