Gastric bypass and banding equally improve insulin sensitivity and β cell function

Bradley, David; Conte, Caterina; Mittendorfer, Bettina; Eagon, J. Christopher; Varela, J. Esteban; Fabbrini, Elisa; Gastaldelli, Amalia; Chambers, Kari T.; Su, Xiong; Okunade, Adewole L.; Patterson, Bruce W.; Klein, Samuel

doi:10.1172/jci64895

Cited by 229 publications

(211 citation statements)

References 43 publications

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“…Others also have shown that a matched 20% weight loss by either RYGBP or adjustable gastric banding (LAGB) result in similar improvement of insulin sensitivity. 67,68 These data demonstrate that the amount rather than the method of weight loss is important for the increase in insulin sensitivity. However, the greater improvement in β-cell function measured during an oral glucose challenge, after RYGBP compared with diet weight loss 7,69 underscores the importance of the engagement of the gut and the incretin effect, rather than weight loss, in the metabolic response to nutrient ingestion after RYGBP.…”

Section: Diabetes Relapsementioning

confidence: 80%

Bariatric surgery and obesity: influence on the incretins

Laferrère

2016

Int J Obes Supp

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The gut hormone incretins have an important physiological role in meal-related insulin release and post-prandial glucose control. In addition to weight loss, the incretin hormones have a role in glucose control after bariatric surgery. The release of incretins, and specifically of glucagon-like peptide (GLP)-1, in response to the ingestion of nutrients, is greatly enhanced after gastric bypass (RYGBP). The rapid transit of food from the gastric pouch to the distal ileum is responsible for the greater GLP-1 release after RYGBP. The incretin effect on insulin secretion, or the greater insulin response to oral glucose compared to an isoglycemic intravenous glucose challenge, is severely impaired in patients with type 2 diabetes, but is recovered rapidly after RYGBP. The improvement in insulin secretion rate and β-cell sensitivity to oral glucose after RYGBP is mediated by endogenous GLP-1, and is abolished by exendin 9-39, a specific GLP-1 receptor antagonist. While calorie restriction and weight loss have major effects on the rapid and sustained improvement of fasted glucose metabolism, the enhanced incretin effect is a key player in post-prandial glucose control after RYGBP.

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Section: Diabetes Relapsementioning

confidence: 80%

Bariatric surgery and obesity: influence on the incretins

Laferrère

2016

Int J Obes Supp

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“…1-3). (21) 258 (22) 140 (59) 90 (27) 419 (35) 68 (29) 170 (51) 516 (43) 30 ( (14) 65 (8) 42 (25) 32 (16) 197 (23) 68 (40) 144 (71) 579 (69) 61 ( Figure 1A-C suggests that reductions in glucose, insulin, and HOMA-IR increase with increasing weight loss. Moreover, the slopes of the regression analyses revealed that weight changes at 2 and 10 years were, for all performed analyses, associated with changes in glucose, insulin, and HOMA-IR within each of the surgery groups (Table 2).…”

Section: Resultsmentioning

confidence: 98%

“…In patients without type 2 diabetes, it was shown that the improvement in insulin sensitivity was determined by the amount of weight lostdnot whether the patients had been treated with GBP or caloric restriction (29). Furthermore, another study of patients without type 2 diabetes showed that effects on insulin sensitivity and b-cell function were similar after GBP and banding after 20% weight loss, occurring after 16 and 22 weeks, respectively (27). Consequently, it is important to investigate whether long-term effects on risk factor changes are similar after GBP compared with restrictive procedures when adequate adjustments for degree of weight loss have been performed.…”

Section: Discussionmentioning

confidence: 99%

Weight Change–Adjusted Effects of Gastric Bypass Surgery on Glucose Metabolism: 2- and 10-Year Results From the Swedish Obese Subjects (SOS) Study

et al. 2015

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OBJECTIVEIt has been suggested that weight change-independent effects on fasting insulin and glucose levels are present after gastric bypass (GBP) but not after banding and vertical banded gastroplasty (VBG). We therefore evaluated weight change-adjusted effects of GBP, compared with restrictive surgical procedures, on long-term changes in fasting levels of glucose, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR) in the Swedish Obese Subjects (SOS) study. RESEARCH DESIGN AND METHODSParticipants who completed the 2-year (n = 1,762) and/or the 10-year (n = 1,216) follow-up were divided into three weight change classes (weight loss >30%, 20-30%, or £20%), and by surgical method (banding, VBG, or GBP). Glucose, insulin, and HOMA-IR changes were analyzed in relation to weight change over 2 and 10 years. Analyses were performed in the full cohort and also in subgroups based on baseline glucose status. RESULTSWithin weight change classes, reductions in glucose, insulin, and HOMA-IR were similar in the three surgery groups both at 2 and at 10 years. Reductions in glucose, insulin, and HOMA-IR increased with increasing weight loss, and changes were typically related to weight change within each surgery group. Moreover, the association between weight change and change in glucose, insulin, or HOMA-IR did not differ between the surgery groups at 2 and 10 years. When patients were subdivided also by baseline glucose status, similar relationships between weight changes and changes in glucose, insulin, and HOMA-IR were observed. CONCLUSIONSEven though weight loss-independent effects are important for short-term diabetes remission, our results suggest that degree of weight loss is more important for long-term reductions in fasting insulin and glucose than choice of bariatric surgery procedure.

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“…Challenging that assertion, Halpern et al (1) cite the Swedish Obese Subjects (SOS) study, a population-based investigation not designed to address this question. They also mention one publication (8) showing that with major weight loss long after surgery (20% of total body weight), glucose homeostasis improvements appeared fairly similar between recipients of RYGB and gastric banding. Such substantial long-term weight loss, however, might mask additional weight-independent glycemic benefits, which are not disproven by this one article.…”

mentioning

confidence: 95%

Response to Comment on Cummings and Cohen. Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2. Diabetes Care 2016;39:924–933

Cummings

Cohen

2017

Diabetes Care

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(1) thoughtfully critique our article (2) on bariatric/metabolic surgery for type 2 diabetes (T2D) in lower-BMI patients. The traditional 35 kg/m 2 BMI threshold for patients with diabetes to be surgical candidates is arbitrary and particularly unsuitable for Asians. The National Institutes of Health established this threshold 26 years ago based on no randomized controlled trials (RCTs) comparing surgical versus nonsurgical approaches. Nevertheless, a quarter century of worldwide practice governed by those standards has validated that among severely obese patients, bariatric/metabolic surgery is efficacious, safe, and cost-effective (3).A key question now is whether the well-documented benefits of these operations extend to patients with diabetes whose BMI is ,35 kg/m 2 . Among many reasons justifying this question is abundant evidence demonstrating that preoperative BMI does not predict the benefits of surgery on diabetes prevention, remission, or relapse, nor on cardiovascular events, cancer, or death (3).Halpern et al. (1) emphasize that longterm surgical outcomes data in lower-BMI populations are limited. The relevant database, however, is far from trivial and is growing rapidly. We generated forest plots displaying results from 11 existing RCTs that compared glycemic benefits from bariatric/metabolic surgery against various medical/lifestyle interventions (2). Surgery was universally superior, yielding similar results among trials with mean preoperative BMI above and below 35 kg/m 2 . Halpern et al. (1) focused on a few of these trials to bolster their assertions, but results from the entire data set seem more relevant. They constitute Level 1a evidence demonstrating that the superiority of surgical over nonsurgical T2D interventions is equally strong with baseline BMI above or below 35 kg/m 2 . A superb RCT (4) Adding to this evidence, we generated another forest plot revealing that among the 11 aforementioned RCTs, the magnitude of surgical superiority over medical/ lifestyle interventions remains similar throughout follow-up times from 6 months through at least 5 years (5). These data include four RCTs with longer-term follow-up among patients with baseline BMI ,35 kg/m 2 , not one study, as Halpern et al. (1) claim.An encyclopedic meta-analysis of all publications reporting diabetes remission after bariatric/metabolic surgery (including 94,579 patients with T2D) found that remission rates were equivalent between the group of 34 studies in which mean preoperative BMI was ,35 kg/m 2 and the group of 60 studies with mean preoperative BMI $35 kg/m 2 : 72% vs. 71%, respectively (6).Admittedly, lower-BMI patients lose less weight postoperatively and thus enjoy fewer weight-dependent antidiabetes benefits. It is abundantly clear, however, that several bariatric/metabolic operations, such as Roux-en-Y gastric bypass (RYGB), engage additional weight-independent antidiabetes mechanisms, including in lower-BMI individuals (7). Among many bodies of evidence demonstrating this is the greater improvement in glucose ...

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Gastric bypass and banding equally improve insulin sensitivity and β cell function

Cited by 229 publications

References 43 publications

Bariatric surgery and obesity: influence on the incretins

Bariatric surgery and obesity: influence on the incretins

Weight Change–Adjusted Effects of Gastric Bypass Surgery on Glucose Metabolism: 2- and 10-Year Results From the Swedish Obese Subjects (SOS) Study

Response to Comment on Cummings and Cohen. Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2. Diabetes Care 2016;39:924–933

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Gastric bypass and banding equally improve insulin sensitivity and β cell function

Cited by 229 publications

References 43 publications

Bariatric surgery and obesity: influence on the incretins

Bariatric surgery and obesity: influence on the incretins

Weight Change–Adjusted Effects of Gastric Bypass Surgery on Glucose Metabolism: 2- and 10-Year Results From the Swedish Obese Subjects (SOS) Study

Response to Comment on Cummings and Cohen. Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI &lt;35 kg/m2. Diabetes Care 2016;39:924–933

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Response to Comment on Cummings and Cohen. Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2. Diabetes Care 2016;39:924–933