Mechanism for Improved Insulin Sensitivity after Gastric Bypass Surgery

Bikman, Benjamin T.; Zheng, Donghai; Pories, Walter J.; Chapman, William H.; Pender, John R.; Bowden, Rita C.; Reed, Melissa; Cortright, Ronald N.; Tapscott, Edward B.; Houmard, Joseph A.; Tanner, Charles J.; Lee, Ji‐Hyun; Dohm, G. Lynis

doi:10.1210/jc.2008-1030

Cited by 93 publications

(92 citation statements)

References 42 publications

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“…The plasma insulin and glucose excursions during the intravenous glucose tolerance test (IVGTT) for the PP analysis are presented in Figure 3. loss (~20 kg), within 1 to 3 months after surgery, peripheral S I remains approximately 60% lower compared with that of metabolically healthy lean individuals of similar age and the same sex (31). Our data affirm that there is capacity for further improvements through lifestyle interventions, such as exercise.…”

Section: Resultssupporting

confidence: 58%

Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

Coen¹,

Tanner²,

Helbling³

et al. 2014

J. Clin. Invest.

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116

199

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nondiabetic patients following RYGB surgery are typically quite modest compared with the presurgery condition (3). Moreover, there appear to be 2 discrete periods of improvement. The first is immediately after surgery, at which time hepatic, but not peripheral, S I improves in response to acute energy restriction (4-6), while greater, protracted weight loss appears to be more strongly associated with improved peripheral S I (7,8). Even with significant weight loss 1 year following RYBG surgery, peripheral S I is still low compared with that of lean metabolically healthy individuals (3,5,6,9).Exercise is considered a cornerstone for obesity treatment, and while it is not generally viewed to cause substantial body weight reduction (10), it can potently improve peripheral S I and glucose control (11-13) and can reduce the risk of T2D and cardiovascular disease (14,15). There is general consensus that even a single session of moderate intensity exercise can induce an improvement in S I (16). There is also evidence that exercise can BACKGROUND. Roux-en-Y gastric bypass (RYGB) surgery causes profound weight loss and improves insulin sensitivity (S I ) in obese patients. Regular exercise can also improve S I in obese individuals; however, it is unknown whether exercise and RYGB surgery-induced weight loss would additively improve S I and other cardiometabolic factors. METHODS.We conducted a single-blind, prospective, randomized trial with 128 men and women who recently underwent RYGB surgery (within 1-3 months). Participants were randomized to either a 6-month semi-supervised moderate exercise protocol (EX, n = 66) or a health education control (CON; n = 62) intervention. Main outcomes measured included S I and glucose effectiveness (S G ), which were determined from an intravenous glucose tolerance test and minimal modeling. Secondary outcomes measured were cardiorespiratory fitness (VO 2 peak) and body composition. Data were analyzed using an intention-to-treat (ITT) and per-protocol (PP) approach to assess the efficacy of the exercise intervention (>120 min of exercise/week).RESULTS. 119 (93%) participants completed the interventions, 95% for CON and 91% for EX. There was a significant decrease in body weight and fat mass for both groups (P < 0.001 for time effect). S I improved in both groups following the intervention (ITT: CON vs. EX; +1.64 vs. +2.24 min -1 /μU/ml, P = 0.18 for Δ, P < 0.001 for time effect). A PP analysis revealed that exercise produced an additive S I improvement (PP: CON vs. EX; +1.57 vs. +2.69 min

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Section: Resultssupporting

confidence: 58%

Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

Coen¹,

Tanner²,

Helbling³

et al. 2014

J. Clin. Invest.

Self Cite

116

199

View full text Add to dashboard Cite

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“…25,26 The difference in insulin resistance in the postoperative period between the 2 procedures found in this meta-analysis also supports the theory that duodenum exclusion is helpful for the reduction of insulin resistance. In recent studies, Korner and colleagues 27 found that reduction of insulin resistance correlated significantly with weight loss only in patients who underwnt gastric banding, not in those who had gastric bypass, and Bikman and colleagues 28 found that improved insulin sensitivity after gastric bypass was due to something other than weight loss. Because the duodenum was recently found to have a novel intestine-brain-liver neurocircuit to increase hepatic insulin sensitivity, it is possible that gastrointestinal surgery may help mediate antidiabetes effects, although this is currently unclear.…”

Section: Discussionmentioning

confidence: 99%

Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials

Lai

et al. 2013

CJS

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Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for treating morbid obesity is becoming more popular. We compared both techniques to evaluate their efficacy in treating morbid obesity or type 2 diabetes mellitus (T2DM). Methods:We searched the Cochrane Controlled Trials Register databases, Medline, Embase, ISI databases and the Chinese Biomedical Literature Database to identify randomized controlled trials (RCTs) of LRYGB and LSG for morbid obesity or T2DM published in any language. Statistical analyses were carried out using RevMan software.Results: Five worldwide RCTs with 196 patients in the LRYGB group and 200 in the LSG group were included in our analysis. Compared with patients who had LSG, those who had LRYGB had a higher remission rate of T2MD, lost more weight and had lower low-density lipoprotein, triglycerides, homeostasis model assessment index and insulin levels. There was no difference in the reoperation rate between the groups. However, patients treated with LRYGB had a higher incidence of complication than those treated with LSG. Conclusion:Our meta-analysis demonstrates that LRYGB is more effective than LSG for the surgical treatment of T2DM and control of metabolic syndrome. However, LSG is safer and has a reduced rate of complications. Further high-quality RCTs with long follow-up periods are needed to provide more reliable evidence.Contexte : La dérivation gastrique laparoscopique Roux-en-Y (DGRY) est l'une des interventions bariatriques les plus utilisées, et la gastrectomie longitudinale laparoscopique (GLL) gagne en popularité comme intervention en une seule étape pour le traitement de l'obésité morbide. Nous avons comparé les 2 techniques pour en évaluer l'efficacité dans le traitement de l'obésité morbide ou du diabète de type 2 (DT2).

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“…Adjusting palmitate R a for differences in insulin concentrations produced similar results, particularly at HDI, where insulin concentrations were similar in lean and post-gastric bypass subjects. The improvement of insulin sensitivity after gastric bypass in terms of peripheral glucose disposal has been studied using a number of well-established techniques, including calculated indices of insulin sensitivity such as homeostasis of model assessment (3), intravenous (16) and oral glucose tolerance tests (24), and glucose clamps (as we used in our study) (1,3). However, there is only one report showing that lipolysis is reduced after gastric bypass surgery.…”

Section: E748 Insulin Sensitivity After Gastric Bypass Surgerymentioning

confidence: 99%

Gastric bypass surgery is associated with near-normal insulin suppression of lipolysis in nondiabetic individuals

Curry

Roberts²,

Basu

et al. 2011

American Journal of Physiology-Endocrinology and Metabolism

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We hypothesized that individuals who have undergone gastric bypass have greater insulin sensitivity that obese subjects but less compared with lean. We measured free fatty acid (FFA) and glucose kinetics during a two-step, hyperinsulinemic euglycemic clamp in nondiabetic subjects who were 38 Ϯ 5 mo post-gastric bypass surgery (GB; n ϭ 15), in lean subjects (L; n ϭ 15), and in obese subjects (O; n ϭ 16). Fasting FFAa were not significantly different between the three study groups but during both doses of insulin were significantly higher in O than in either GB or L. The effective insulin concentration resulting in half-maximal suppression of FFA was similar in L and GB and significantly less in both groups compared with O. Glucose infusion rates during low-dose insulin were not significantly different in GB compared with either L or O. During high-dose insulin, glucose infusion rates were significantly greater in GB than in O but less than in L. Endogenous glucose production in GB was significantly lower than O only during low dose of insulin. We conclude that gastric bypass is associated with improvements in adipose tissue insulin sensitivity to levels similar to lean, healthy persons and also with improvements in the response of glucose metabolism to insulin. These changes may be due to preferential reduction in visceral fat and decreased FFA availability. However, some differences in insulin sensitivity in GB remain compared with L. Residual insulin resistance may be related to excess total body fat or abnormal lipolysis and requires further study. insulin sensitivity; glucose; body composition; obesity OBESITY IS FREQUENTLY ACCOMPANIED by insulin resistance (5). Elevated circulating free fatty acid (FFA) concentrations, due to increased adipose tissue lipolysis, are thought to mediate insulin resistance in both obesity and type 2 diabetes (4). Weight loss via a hypocaloric diet has been shown to reduce lipolysis in obese individuals (14). However, although gastric bypass surgery has been shown to improve insulin action on glucose metabolism, relatively little is known about the effect of gastric bypass surgery on the insulin sensitivity of adipose tissue.We measured FFA kinetics during a two-step hyperinsulinemic euglycemic clamp in nondiabetic individuals who had undergone gastric bypass surgery and in nondiabetic lean and obese subjects. We hypothesized that gastric bypass subjects have greater insulin sensitivity with respect to lipolysis compared with obese subjects but less than lean subjects. We also hypothesized that gastric bypass subjects would have greater insulin sensitivity with respect to glucose kinetics than obese subjects but less than lean subjects and that there would be a relationship between adipose tissue insulin sensitivity and the sensitivity of glucose metabolism to insulin.Research design and methods. The Mayo Institutional Review Board approved the study, and subjects gave informed consent. The Mayo Clinical Research Unit (CRU) was used for this study. Three groups of nondiabetic sub...

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Mechanism for Improved Insulin Sensitivity after Gastric Bypass Surgery

Cited by 93 publications

References 42 publications

Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials

Gastric bypass surgery is associated with near-normal insulin suppression of lipolysis in nondiabetic individuals

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