Altered glucose metabolism after bariatric surgery: What's GLP-1 got to do with it?

Smith, Eric P.; Polanco, Georgina; Yaqub, Abid; Salehi, Marzieh

doi:10.1016/j.metabol.2017.10.014

Cited by 39 publications

(27 citation statements)

References 89 publications

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“…However, the mechanism by which bariatric surgery improves glucose metabolism is unclear. Change of hormone secretion in the gastrointestinal tract may be one of those mechanisms [38,39]. RBP4 plays an important role in insulin resistance, and the improved glucose metabolism after LSG may be related to RBP4.…”

Section: Discussionmentioning

confidence: 99%

Changes of serum retinol-binding protein 4 associated with improved insulin resistance after laparoscopic sleeve gastrectomy in Chinese obese patients

Wang

Huang

Gao

et al. 2020

Diabetol Metab Syndr

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Background: Serum retinol-binding protein 4 (RBP4) plays a critical role in insulin resistance. The mechanism behind the impact of laparoscopic sleeve gastrectomy (LSG) on glucose metabolism is unclear. Hence, we aimed to investigate the triangle relationship between the RBP4, glucose metabolism, and LSG in patients of Chinese ethnicity. Methods:The study enrolled eighty-two obese patients. Glucose-lipid metabolic index, uric acid (UA), superoxide dismutase (SOD), free triiodothyronine (FT3), free thyroxin (FT4) and thyrotropin (TSH) were measured. RBP4 levels were detected by enzyme-link immunosorbent assay. 30 obese patients underwent LSG were studied. All these markers were measured again at a time interval of 3 and 6 months after surgery. Results:(1) Circulating RBP4 levels were positively associated with body mass index(BMI), blood glucose in 0 min (BG0), BG30, BG120, BG180, fasting inulin(FINS), fasting C peptide(FCP), homeostasis model of assessment for insulin resistance index (HOMA-IR), SOD, TSH and negatively associated with Matsuda index in obesity with a significant difference (P < 0.05). RBP4 levels in the patients with impaired fasting glucose (IFG), insulin resistance or hyperinsulinemia were significantly higher than the patients without IFG, insulin resistance or hyperinsulinemia (P = 0.035, P = 0.001, and P = 0.007).(2) LSG resulted in significantly decreased FBG, FINS, FCP and HOMA-IR at 3, 6 months after surgery (all P < 0.05). The RBP4 levels were significantly decreased after surgery (all P < 0.05) with no gender difference. (3) The change in RBP4 levels was significantly associated with the change in FINS, FCP, HOMA-IR, and HOMA-β at 6 months and the change in TSH at 3 months after surgery in males (all P < 0.05). The change in RBP4 levels were significantly associated with the change in FINS, FCP, HOMA-IR, HOMA-β, and TCH at 3 months after surgery in females (all P < 0.05). Conclusions:Overall, our results interpret the significant correlations between RBP4, glucose-lipid metabolism, oxidative stress and thyroid function in obese patients. Further, the LSG brings a decline in RBP4 levels and that may contribute partly to the improved insulin resistance in obese Chinese patients.

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Section: Discussionmentioning

confidence: 99%

Changes of serum retinol-binding protein 4 associated with improved insulin resistance after laparoscopic sleeve gastrectomy in Chinese obese patients

Wang

Huang

Gao

et al. 2020

Diabetol Metab Syndr

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“…Peak insulin concentrations in gastrectomy patients were approximately 2-fold higher than in control subjects and were restored to normal levels by Exendin-9. Although other studies in obese humans have similarly concluded that GLP-1 plays an important role in driving insulin secretion after bariatric surgery (Jørgensen et al, 2013;Salehi et al, 2014), studies in mice have yielded conflicting results, with some groups arguing in favor (Garibay et al, 2016) and others against (Douros et al, 2018;Wilson-Pé rez et al, 2013) this idea (Hutch and Sandoval, 2017;Smith et al, 2018). Additional improved glucose tolerance arising from concomitant weight loss and improved insulin sensitivity makes the interpretation of these types of study in mice particularly challenging.…”

Section: Discussionmentioning

confidence: 99%

“…Post-gastrectomy patients have elevated plasma glucagon-like peptide (GLP) 1, peptide YY (PYY), and insulin levels after an oral glucose tolerance test (OGTT), mirroring the endocrine changes seen in bariatric patients, but because these patients are not generally obese, the excessive insulin secretion is associated with significant rates of post-prandial hypoglycemia (Roberts et al, 2018b). The contribution of GLP-1 to the observed post-surgical changes in plasma glucose and insulin concentrations has been debated, as detailed in several reviews (Hutch and Sandoval, 2017;Smith et al, 2018). In obese post-bariatric patients, blocking GLP-1 action using Exendin-9 reduced insulin secretion and the incidence of hypoglycemia (Jørgensen et al, 2013;Salehi et al, 2014), but corresponding data from mouse models have been conflicting.…”

Section: Introductionmentioning

confidence: 99%

Important Role of the GLP-1 Axis for Glucose Homeostasis after Bariatric Surgery

Larraufie¹,

Roberts²,

McGavigan³

et al. 2018

SSRN Journal

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“…Post-gastrectomy patients have elevated plasma glucagon-like peptide (GLP) 1, peptide YY (PYY), and insulin levels after an oral glucose tolerance test (OGTT), mirroring the endocrine changes seen in bariatric patients, but because these patients are not generally obese, the excessive insulin secretion is associated with significant rates of post-prandial hypoglycemia ( Roberts et al., 2018b ). The contribution of GLP-1 to the observed post-surgical changes in plasma glucose and insulin concentrations has been debated, as detailed in several reviews ( Hutch and Sandoval, 2017 , Smith et al., 2018 ). In obese post-bariatric patients, blocking GLP-1 action using Exendin-9 reduced insulin secretion and the incidence of hypoglycemia ( Jørgensen et al., 2013 , Salehi et al., 2014 ), but corresponding data from mouse models have been conflicting.…”

Section: Introductionmentioning

confidence: 99%

Important Role of the GLP-1 Axis for Glucose Homeostasis after Bariatric Surgery

et al. 2019

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SummaryBariatric surgery is widely used to treat obesity and improves type 2 diabetes beyond expectations from the degree of weight loss. Elevated post-prandial concentrations of glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and insulin are widely reported, but the importance of GLP-1 in post-bariatric physiology remains debated. Here, we show that GLP-1 is a major driver of insulin secretion after bariatric surgery, as demonstrated by blocking GLP-1 receptors (GLP1Rs) post-gastrectomy in lean humans using Exendin-9 or in mice using an anti-GLP1R antibody. Transcriptomics and peptidomics analyses revealed that human and mouse enteroendocrine cells were unaltered post-surgery; instead, we found that elevated plasma GLP-1 and PYY correlated with increased nutrient delivery to the distal gut in mice. We conclude that increased GLP-1 secretion after bariatric surgery arises from rapid nutrient delivery to the distal gut and is a key driver of enhanced insulin secretion.

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Altered glucose metabolism after bariatric surgery: What's GLP-1 got to do with it?

Cited by 39 publications

References 89 publications

Changes of serum retinol-binding protein 4 associated with improved insulin resistance after laparoscopic sleeve gastrectomy in Chinese obese patients

Changes of serum retinol-binding protein 4 associated with improved insulin resistance after laparoscopic sleeve gastrectomy in Chinese obese patients

Important Role of the GLP-1 Axis for Glucose Homeostasis after Bariatric Surgery

Important Role of the GLP-1 Axis for Glucose Homeostasis after Bariatric Surgery

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