Predictive Value of Gut Peptides in T2D Remission: Randomized Controlled Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy and Greater Curvature Plication

Abstract

mRYGB achieves a superior rate of weight loss and T2D remission at month 12. Enhanced GLP-1 secretion 1 month after surgery was a determinant of glucose metabolism improvement. Registration number ( http://www.clinicaltrials.gov ): NCT14104758.

Postprandial Nutrient Handling and Gastrointestinal Hormone Secretion After Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

“…The enhanced GLP-1 secretion after RYGB is in line with numerous previous reports, but surprisingly, the iAUC of GLP-1 in SG-operated subjects did not differ from that of controls, although a slightly enhanced response was observed just after meal intake. This is in agreement with a few previously published reports, [20][21][22] but it is in direct contrast to other studies reporting equally enhanced GLP-1 after SG and RYGB. [17][18][19] Peak CCK concentration was also considerably higher after RYGB compared with SG and controls, whereas peak GIP concentrations were comparable after both surgical procedures, although the duration of the GIP response was significant longer in the SG-operated subjects than in RYGB.…”

“…13 The improved glycemic control arises from a combination of factors, including increased hepatic and peripheral insulin sensitivity, 14 and improved meal-induced insulin secretion, facilitated by exaggerated GLP-1 secretion. 15 Accelerated gastric emptying and enhanced glucose absorption are also reported after SG, 9,16 and an increased secretion of GLP-1, comparable to that seen after RYGB, has been reported in some, [17][18][19] but not all, [20][21][22] studies. Using the GLP-1 receptor antagonist, exendin 9-39, it has been demonstrated that GLP-1 affects b-cell function and glucose tolerance after both RYGB and SG.…”

Ghrelin, a gastrointestinal hormone, regulates energy balance and lipid metabolism

“…Kalinowski et al [ 39 ] compared the effects of SG and RYGB on ghrelin, leptin, and glucose homeostasis in a randomized controlled trial and found that ghrelin levels decrease after SG but increase after RYGB; however, metabolic improvements are not affected. Casajoana et al [ 40 ] also found that ghrelin levels are higher in the RYGB group than those in the SG and greater curvature plication groups at 1 year. The mechanism may be due to a compensatory increase in ghrelin secretion as an adaptive response that constrains weight loss.…”

Comparison of the effect of Roux‐en‐Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials

“…The literature search identified 2650 unique citations, whereof 2625 were excluded because of irrelevant content, duplication, or non‐English language (Figure ). Of the 25 studies that were full‐text screened, 13 did not meet the inclusion criteria either because follow‐up time was too short, the authors did not differentiate between improvement and remission of T2DM, other bariatric procedures were performed (mini gastric bypass, banded RYGB, and metabolic gastric bypass), the study was not an RCT, no patients in the SG‐group had T2DM, or the study included a subpopulation of an already included RCT . We detected two studies that had been performed in the same study population, and of these, only the study referring to a clinical trial registry number was included .…”