Lower Glycemic Fluctuations Early After Bariatric Surgery Partially Explained by Caloric Restriction

Yip, S.; Signal, Matthew; Smith, Greg; Beban, Grant; Booth, Michael; Babor, Richard; Chase, J. Geoffrey; Murphy, Rinki

doi:10.1007/s11695-013-1043-7

Cited by 16 publications

(20 citation statements)

References 23 publications

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“…This adds to the current discussion about whether the early effects of RYGB and SG surgery on obesity-associated comorbidities, such as T2DM and cardiovascular disease, can be solely attributed to the significant postoperative calorie restriction, as suggested by a number of recent studies (15,24,42,47). BMS rats consumed more food than RYGB rats in this study, because the BMS rats had higher glucose levels and, thus, lost many of consumed calories in their urine in contrast with the RYGB rats that had higher energy efficiency, as their glucose levels did not exceed the renal threshold and, thus, fewer calories were lost in the urine.…”

Section: Discussionmentioning

confidence: 88%

Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats

Abegg

Corteville

Docherty

et al. 2015

American Journal of Physiology-Regulatory, Integrative and Comp

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Abegg K, Corteville C, Docherty NG, Boza C, Lutz TA, Muñoz R, le Roux CW. Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats. Am J Physiol Regul Integr Comp Physiol 308: R321-R329, 2015. First published December 24, 2014 doi:10.1152/ajpregu.00331.2014.-Bariatric surgery rapidly improves Type 2 diabetes mellitus (T2DM). Our objective was to profile and compare the extent and duration of improved glycemic control following Roux-en-Y gastric (RYGB) bypass surgery and vertical sleeve gastrectomy (SG) and compare against calorie restriction/weight loss and medical combination therapy-based approaches using the Zucker diabetic fatty rat (ZDF) rodent model of advanced T2DM. Male ZDF rats underwent RYGB (n ϭ 15) or SG surgery (n ϭ 10) at 18 wk of age and received postsurgical insulin treatment, as required to maintain mid-light-phase glycemia within a predefined range (10 -15 mmol/l). In parallel, other groups of animals underwent sham surgery with ad libitum feeding (n ϭ 6), with body weight (n ϭ 8), or glycemic matching (n ϭ 8) to the RYGB group, using food restriction or a combination of insulin, metformin, and liraglutide, respectively. Both bariatric procedures decreased the daily insulin dose required to maintain mid-light-phase blood glucose levels below 15 mmol/l, compared with those required by body weight or glycemia-matched rats (P Ͻ 0.001). No difference was noted between RYGB and SG with regard to initial efficacy. SG was, however, associated with higher food intake, weight regain, and higher insulin requirements vs. RYGB at study end (P Ͻ 0.05). Severe hypoglycemia occurred in several rats after RYGB. RYGB and SG significantly improved glycemic control in a rodent model of advanced T2DM. While short-term outcomes are similar, long-term efficacy appears marginally better after RYGB, although this is tempered by the increased risk of hypoglycemia. bariatric surgery; Roux-en-Y gastric bypass; sleeve gastrectomy; glycemic control; medical therapy; caloric restriction; Zucker diabetic fatty rat ROUX-EN-Y GASTRIC BYPASS (RYGB) and vertical sleeve gastrectomy (SG) surgery can be used as a treatment alternative to intensive management in obese patients (body mass index Ͼ30 kg/m 2 ) with Type 2 diabetes mellitus (T2DM) (5, 29, 39).After these operations, most patients have improved glycemic control, and ϳ40% of patients achieve a HbA1c Ͻ42 mmol/ mol (6%) after one year. It remains controversial whether RYGB and SG lead to comparable rates of metabolic improvement and T2DM remission. Some studies report a higher T2DM remission rate or that glycemic targets can be achieved with fewer medications after RYGB compared with SG surgery (3, 22, 23, 32), while others show a similar glycemic outcome for both procedures (12,16,28,46). Data on longterm remission and relapse rates are scarce, but at 3 years, 38% of those after RYGB and 24% of those after SG had a HbA1c Ͻ42 mmol/l (6%) (39). The use ...

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Section: Discussionmentioning

confidence: 88%

Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats

Abegg

Corteville

Docherty

et al. 2015

American Journal of Physiology-Regulatory, Integrative and Comp

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“…The GLP-1 analogues exenatide and liraglutide are used in the treatment of type 2 diabetes. Six studies have shown that GLP-1 is not increased after medical weight loss and may be decreased (54, 55, 71, 87–90). Only 1 of 10 studies in AGB showed an increase in GLP-1, and in that one study it was increased less than RYGB (30); the others showed no change (8, 21, 22, 56, 57, 68, 91–93).…”

Section: Resultsmentioning

confidence: 99%

“…Every malabsorptive procedure exhibits an increase in GLP-1 (for a discussion of the impact of bile acids on GLP-1, see the section below). RYGB has been especially well-studied with 19 of 20 studies showing an increase in GLP-1 after RYGB (8, 21, 37–39, 42, 49, 50, 56, 57, 68, 71, 84, 87, 90, 91, 94–96), and only 1 study showing a decrease (92). The increase in GLP-1 has been shown to occur prior to weight loss, and may contribute to the early remission of diabetes (84).…”

Section: Resultsmentioning

confidence: 99%

Metabolic surgery: Action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature

Sweeney

Morton

2014

Best Practice & Research Clinical Gastroenterology

105

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Obesity and type 2 diabetes remain epidemic problems. Different bariatric surgical techniques causes weight loss and diabetes remission to varying degrees. The underlying mechanisms of the beneficial effects of bariatric surgery are complex, and include changes in diet and behavior, as well as changes in hormones, bile acid flow, and gut bacteria. We summarized the effects of multiple different bariatric procedures, and their resulting effects on several hormones (leptin, ghrelin, adiponectin, glucagon-like peptide 1 (GLP-1), peptide YY, and glucagon), bile acid changes in the gut and the serum, and resulting changes to the gut microbiome. As much as possible, we have tried to incorporate multiple studies to try to explain underlying mechanistic changes. What emerges from the data is a picture of clear differences between restrictive and metabolic procedures. The latter, in particular the roux-en-Y gastric bypass, induces large and distinctive changes in most measured fat and gut hormones, including early and sustained increase in GLP-1, possible through intestinal bile acid signaling. The changes in bile flow and the gut microbiome are causally inseparable so far, but new studies show that each contributes to the effects of weight loss and diabetes resolution.

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“…Fifteen obese subjects participating in a prospective bariatric surgery study [15] (8 scheduled for GBP, 7 for SG) were selected for this study based on similarity of baseline characteristics (Table 1). All patients were treated with metformin for T2D prior to surgery only.…”

Section: Resultsmentioning

confidence: 99%

“…A non-randomised, matched, prospective controlled intervention trial that compared the acute effect of GBP to SG, compared with matched caloric intake, on glycemia among obese patients with type 2 diabetes has been previously described with its inclusion and exclusion criteria [15]. Briefly, from 1 August 2010 to 31 March 2012, 21 obese patients with type 2 diabetes treated with oral glucose lowering therapies (but not incretin hormone therapies) were recruited by contacting patients on the bariatric surgery waiting lists, 10 who were scheduled for SG and 11 who were scheduled for GBP.…”

Section: Methodsmentioning

confidence: 99%

Lower Fetuin-A, Retinol Binding Protein 4 and Several Metabolites after Gastric Bypass Compared to Sleeve Gastrectomy in Patients with Type 2 Diabetes

Jüllig

Yip

et al. 2014

PLoS ONE

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BackgroundBypass of foregut secreted factors promoting insulin resistance is hypothesized to be one of the mechanisms by which resolution of type 2 diabetes (T2D) follows roux-en-y gastric bypass (GBP) surgery.AimTo identify insulin resistance-associated proteins and metabolites which decrease more after GBP than after sleeve gastrectomy (SG) prior to diabetes remission.MethodsFasting plasma from 15 subjects with T2D undergoing GBP or SG was analyzed by proteomic and metabolomic methods 3 days before and 3 days after surgery. Subjects were matched for age, BMI, metformin therapy and glycemic control. Insulin resistance was calculated using homeostasis model assessment (HOMA-IR). For proteomics, samples were depleted of abundant plasma proteins, digested with trypsin and labeled with iTRAQ isobaric tags prior to liquid chromatography-tandem mass spectrometry analysis. Metabolomic analysis was performed using gas chromatography-mass spectrometry. The effect of the respective bariatric surgery on identified proteins and metabolites was evaluated using two-way analysis of variance and appropriate post-hoc tests.ResultsHOMA-IR improved, albeit not significantly, in both groups after surgery. Proteomic analysis yielded seven proteins which decreased significantly after GBP only, including Fetuin-A and Retinol binding protein 4, both previously linked to insulin resistance. Significant decrease in Fetuin-A and Retinol binding protein 4 after GBP was confirmed using ELISA and immunoassay. Metabolomic analysis identified significant decrease of citrate, proline, histidine and decanoic acid specifically after GBP.ConclusionGreater early decrease was seen for Fetuin-A, Retinol binding protein 4, and several metabolites after GBP compared to SG, preceding significant weight loss. This may contribute to enhanced T2D remission observed following foregut bypass procedures.

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Lower Glycemic Fluctuations Early After Bariatric Surgery Partially Explained by Caloric Restriction

Abstract: GBP and SG have a similar acute impact on reducing glycaemia to caloric restriction; however, with a superior impact on glucose tolerance.

Cited by 16 publications

References 23 publications

Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats

Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats

Metabolic surgery: Action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature

Lower Fetuin-A, Retinol Binding Protein 4 and Several Metabolites after Gastric Bypass Compared to Sleeve Gastrectomy in Patients with Type 2 Diabetes

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