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Acute and long-term effects of Roux-en-Y gastric bypass on glucose metabolism in subjects with type 2 diabetes and normal glucose tolerance.
MedLine Citation:
PMID:  22535748     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Aims: To study the potential mechanisms responsible for the improvement in glucose control in type 2 diabetes (T2D) within days after Roux-en-Y gastric bypass (RYGB). Method: Thirteen obese subjects with T2D and twelve matched subjects with normal glucose tolerance (NGT) were examined during a liquid meal before (pre), one week (1 wk), 3 months and 1 year after RYGB. Glucose, insulin, C-peptide, GLP-1, GIP and glucagon concentrations were measured. Insulin resistance (HOMA-IR), beta cell glucose sensitivity (β-GS) and disposition index (D(β-GS): β-GS x 1/HOMA-IR) were calculated. Results: Within the first week after RYGB fasting glucose (T2D pre: 8.8±2.3, 1 wk: 7.0±1.2 (p<0.001)) and insulin concentrations decreased significantly in both groups. 120 min glucose concentrations decreased in T2D (pre: 11.4±3, 1 wk: 8.2±2 (p=0.003)) but not in NGT. HOMA-IR decreased by 50% in both groups. β-GS increased in T2D (pre: 1.03±0.49, 1 wk: 1.79±1.2, (p=0.012)), but did not change in NGT. The increase in DI(β-GS) was 3-fold in T2D and 1.5-fold in NGT. After RYGB, glucagon secretion was increased in response to the meal. GIP secretion was unchanged, while GLP-1 secretion increased more than 10-fold in both groups. The changes induced by RYGB were sustained or further enhanced 3 months and 1 year after surgery. Conclusions: Improvement in glycaemic control in T2D after RYGB occurs within days after surgery, and is associated with increased insulin sensitivity and improved beta cell function, the latter of which may be explained by dramatic increases in GLP-1 secretion. www.clinicaltrials.gov (ClinicalTrials.gov ID NCT00810823).
Authors:
Nils B Jorgensen; Siv H Jacobsen; Carsten Dirksen; Kirstine N Bojsen-Moller; Lars Naver; Lisbeth Hvolris; Trine R Clausen; Birgitte S Wulff; Dorte Worm; Dorte L Hansen; Sten Madsbad; Jens J Holst
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-24
Journal Detail:
Title:  American journal of physiology. Endocrinology and metabolism     Volume:  -     ISSN:  1522-1555     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100901226     Medline TA:  Am J Physiol Endocrinol Metab     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Hvidovre Hospital.
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