Effects of different metabolic states and surgical models on glucose metabolism and secretion of ileal L‐cell peptides: results from the HIPER‐1 study

Abstract

Aim To compare the impact of four surgical procedures (mini‐gastric bypass, sleeve gastrectomy, ileal transposition and transit bipartition) vs medical management on gut peptide secretion, β‐cell function and resolution of hyperglycaemia in people with type 2 diabetes. Research design and methods A mixed‐meal tolerance test was administered 6–24 months after each surgical procedure (mini‐gastric bypass, sleeve gastrectomy, ileal transposition and transit bipartition; n=30 in each group) and the results were compared with those obtained in matched lean (n=30) and obese (n=30) people with type 2 diabetes undergoing medical management. Results Participants in the mini‐gastric bypass and ileal transposition groups had a greater increase in plasma glucose concentration after the mixed‐meal tolerance test than those in the sleeve gastrectomy and transit bipartition groups. Participants in the mini‐gastric bypass group exhibited the greatest increase in the incremental area under the curve of plasma glucose concentration above baseline (P<0.0001). Insulin sensitivity was similar across surgical groups, and statistically greater in participants in the surgical groups than in obese participants in the non‐surgical group (P<0.0001). β‐cell responsiveness to glucose was greater in participants in the sleeve gastrectomy and transit bipartition groups than in the mini‐gastric bypass and ileal transposition groups (P<0.001) despite a smaller incremental increase above baseline in the area under the plasma glucagon‐like peptide‐1 concentration curve relative to ileal transposition. Postoperative β‐cell function was the strongest predictor of hyperglycaemia resolution. Conclusions The present study showed that the level of β‐cell function after bariatric surgery is the strongest predictor of hyperglycaemia resolution. The study also demonstrates a disconnect between postprandial GLP‐1 levels and β‐cell function among the studied surgical procedures.

Testosterone Changes in Men With Obesity and Type 2 Diabetes 6 Months After Sleeve Gastrectomy With Transit Bipartition

“…Thus, we herein compare them to those of established MBS procedures. Publications reporting general SG-TB outcomes to date have found the procedure safe and effective in the early and medium terms 3–13. Our previous evaluation of SG-TB found a BMI of 27.6±2.7 kg/m 2 at the 4-year study end point (BMI change 7.5±2.8 kg/m 2 , P <0.001) and 79.2% complete T2DM remission (A1C<6.5%, off medications for 1 y) with a mean A1C of 6.3±0.5% (percentage decrease 36.7±11.6%) in 38 patients (86.4%).…”

“…Publications reporting general SG-TB outcomes to date have found the procedure safe and effective in the early and medium terms. [3][4][5][6][7][8][9][10][11][12][13] Our previous evaluation of SG-TB found a BMI of 27.6 ± 2.7 kg/m 2 at the 4-year study end point (BMI change 7.5 ± 2.8 kg/m 2 , P < 0.001) and 79.2% complete T2DM remission (A1C < 6.5%, off medications for 1 y) with a mean A1C of 6.3 ± 0.5% (percentage decrease 36.7 ± 11.6%) in 38 patients (86.4%). In our current SG-TB study, BMI reduction and testosterone increase were significantly correlated.…”

“…SG with transit bipartition (SG-TB) is a relatively new MBS procedure initiated by Santoro and colleagues and reported in their cohort of 1020 patients in 2012 2,3. A number of studies have described a safe and effective experience with SG-TB over the early and medium terms,3–13 including our own report of results at 4 years 14. Although SG-TB is still considered an investigational procedure by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), it was designed to facilitate metabolic improvements similar to those achieved by biliopancreatic diversion with duodenal switch without the technical complexity or long-term nutritional challenges 3…”

Weight Loss, Type 2 Diabetes, and Nutrition in 355 Patients with Obesity Undergoing Sleeve Gastrectomy with Transit Bipartition: Two-Year Outcomes

“…In the few SG-TB reports to date [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 15 , 21 ], this procedure appears to effect marked weight loss and reduction of comorbid disease, particularly T2D, with minimal complications and without causing malnutrition. Recently, we reported initial outcomes of our complete SG-TB series performed in patients with class 1 and 2 obesity ( n = 883, mean preoperative BMI 34.1 ± 5.0 kg/m 2 ) and diagnosed T2D ( n = 883) [ 18 ].…”

Brazilian Multi-Society Position Statement on Emerging Bariatric and Metabolic Surgical Procedures

“…Cagiltay et al 7 compared sleeve gastrectomy (SG), OAGB, ileal transposition, and SGTB. They demonstrated that SGTB had the lowest glucose elevations after a mixed meal, with the greatest beta cell responsiveness to glucose measured as ΔC-peptide/Δglucose 0-120 in transit bipartition.…”