Prospective evaluation of insulin and incretin dynamics in obese adults with and without diabetes for 2 years after Roux-en-Y gastric bypass

Purnell, Jonathan Q.; Johnson, Geoffrey S.; Wahed, Abdus S.; Man, Chiara Dalla; Piccinini, Francesca; Cobelli, Claudio; Prigeon, Ronald L.; Goodpaster, Bret H.; Kelley, David E.; Staten, Myrlene A.; Foster-Schubert, Karen E.; Cummings, David E.; Flum, David R.; Courcoulas, Anita P.; Havel, Peter J.; Wolfe, Bruce M.

doi:10.1007/s00125-018-4553-y

Cited by 35 publications

(35 citation statements)

References 48 publications

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“…Furthermore, bariatric surgery may improve pancreatic beta-cell function [18,21,30]. This effect appears to be the most important among non-diabetics and patients with recent onset of diabetes where beta-cell dysfunction is only limited [18]. In the present study, the effect on prediabetes was significant.…”

Section: Discussionsupporting

confidence: 44%

“…An increase in insulin level is associated with weight-gain in patients with diabetes [33], and a fall in insulin level may be a contributing factor to weight loss after bariatric surgery [34]. Furthermore, bariatric surgery may improve pancreatic beta-cell function [18,21,30]. This effect appears to be the most important among non-diabetics and patients with recent onset of diabetes where beta-cell dysfunction is only limited [18].…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic bariatric surgery has a low complication rate [2,8], and is considered an effective treatment for diabetes in patients with morbid obesity [9][10][11][12], with documented reduction in microand macrovascular complications [13,14]. Gastric bypass and sleeve gastrectomy have both been reported to reduce peripheral insulin resistance and improve glucose homeostasis in patients with type 2 diabetes and to some extent in patients without type-2 diabetes at the time of surgery [12,[15][16][17][18][19][20][21][22][23]. Previous studies in patients with impaired glucose tolerance or impaired fasting glucose are more scarce.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Laparoscopic Gastric Bypass Surgery on Insulin Resistance and Glycosylated Hemoglobin A1c: a 2-Year Follow-up Study

et al. 2020

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Background Bariatric surgery improves insulin sensitivity and secretion in patients with type 2 diabetes, but the effect on patients with prediabetes or even normal glucose tolerance deserves further consideration. Methods Cohort study including patients operated with laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) between November 2012 and June 2017 at the Örebro University Hospital (n = 813) with follow-up of 742 patients 2 years after surgery. Fasting insulin, glucose, glycosylated hemoglobin (HbA1c), and homeostatic model assessment of insulin resistance (HOMA-IR) were analyzed at baseline and 2 years after surgery for patients with overt type 2 diabetes, prediabetes, or non-diabetes. Results Fasting insulin levels improved for all groups (

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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of Laparoscopic Gastric Bypass Surgery on Insulin Resistance and Glycosylated Hemoglobin A1c: a 2-Year Follow-up Study

et al. 2020

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“…RYGB surgery could reduce food intake and absorption by directly linking small stomach capsule and small intestine, which has been studied earlier and performed more frequently in patients with weight loss and diabetes. Moreover RYGB is most effective in treating patients with obesity accompanied by type 2 diabetes [6,7]. Sleeve gastrectomy would remove about 70% of stomach volume and keep the main part responsible for digesting food.…”

Section: Introductionmentioning

confidence: 99%

Comparative Effects of Three Kinds of Bariatric Surgery: A Randomized Case–Control Study in Obese Patients

et al. 2019

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Introduction: Laparoscopic bariatric surgery is necessary for obese patients who cannot control body weight through daily diet and exercise, or other non-surgical ways. Three kinds of laparoscopic bariatric surgery, namely Roux-en-Y gastric bypass, sleeve gastrectomy, and sleeve gastrectomy with jejunal bypass, are available for weight loss in clinical practice, but their comparative effects are unclear. In this study, these were compared to illustrate their clinical effects. Methods: A case-control study was conducted on 175 participants who fulfilled the inclusion criteria of laparoscopic bariatric surgery, while the controls were the same subjects before and after surgery, as well as with different surgeries specifically. Standardized weight loss measures were compared using analysis of covariance, with months from surgery as the covariant, including percentage total weight loss and excess body mass index (BMI) loss. Results: A total of 175 patients were enrolled in this study (age 38 ± 10 years; BMI 46 ± 5 kg/ m 2), with a mean postsurgery follow-up of 18 ± 6 months. No significant difference was included among the enlisted patients before bariatric surgery. However, after surgery according to personal health indexes of patients and professional assessment by doctors, patients specifically receiving one of Roux-en-Y gastric bypass, sleeve gastrectomy, and sleeve gastrectomy with jejunal bypass had no significant difference between weight loss and BMI, while the most important factors were dietary control and exercise after bariatric surgery. Conclusion: This study suggests that bariatric surgery is only a prerequisite for weight loss, and the long-term dietary control and exercise can help patients achieve optimal weight loss. Dan Luo and Qingling Yang are co-first authors.

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“…5 15 Purnell et al showed a reduction in mean fasting glucagon level in diabetics undergoing RYGB and a progressive postsurgical enhancement of the peak glucagon response to an MMT stimulus at follow-up to 24 months, at odds with our findings. 12 However, they reported values of glucagon approximately 20-fold observed by us and other research groups, possibly due to a technical issue with their Millipore immunoassay, making their results difficult to interpret. Jorsal et al also used the Mercodia assay and the C-terminal assay to measure the response of glucagon to an MMT stimulus in eight patients undergoing RYGB at 3 months and 1 week prior to surgery, and at 1 week and 3 months after surgery.…”

Section: Discussionmentioning

confidence: 72%

Proglucagon peptide secretion profiles in type 2 diabetes before and after bariatric surgery: 1-year prospective study

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Howard³

et al. 2020

BMJ Open Diab Res Care

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IntroductionHyperglucagonemia is a key pathophysiological driver of type 2 diabetes. Although Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for diabetes, it is presently unclear how surgery alters glucagon physiology. The aim of this study was to characterize the behavior of proglucagon-derived peptide (glucagon, glucagon-like peptide-1 (GLP-1), oxyntomodulin, glicentin) secretion after RYGB surgery.Research design and methodsProspective study of 19 patients with obesity and pre-diabetes/diabetes undergoing RYGB. We assessed the glucose, insulin, GLP-1, glucose-dependent insulinotropic peptide (GIP), oxyntomodulin, glicentin and glucagon responses to a mixed-meal test (MMT) before and 1, 3 and 12 months after surgery. Glucagon was measured using a Mercodia glucagon ELISA using the ‘Alternative’ improved specificity protocol, which was validated against a reference liquid chromatography combined with mass spectrometry method.ResultsAfter RYGB, there were early improvements in fasting glucose and glucose tolerance and the insulin response to MMT was accelerated and amplified, in parallel to significant increases in postprandial GLP-1, oxyntomodulin and glicentin secretion. There was a significant decrease in fasting glucagon levels at the later time points of 3 and 12 months after surgery. Glucagon was secreted in response to the MMT preoperatively and postoperatively in all patients and there was no significant change in this postprandial secretion. There was no significant change in GIP secretion.ConclusionsThere is a clear difference in the dynamics of secretion of proglucagon peptides after RYGB. The reduction in fasting glucagon secretion may be one of the mechanisms driving later improvements in glycemia after RYGB.Trial registration numberNCT01945840.

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Prospective evaluation of insulin and incretin dynamics in obese adults with and without diabetes for 2 years after Roux-en-Y gastric bypass

Abstract: ClinicalTrials.gov NCT00433810.

Cited by 35 publications

References 48 publications

The Effect of Laparoscopic Gastric Bypass Surgery on Insulin Resistance and Glycosylated Hemoglobin A1c: a 2-Year Follow-up Study

The Effect of Laparoscopic Gastric Bypass Surgery on Insulin Resistance and Glycosylated Hemoglobin A1c: a 2-Year Follow-up Study

Comparative Effects of Three Kinds of Bariatric Surgery: A Randomized Case–Control Study in Obese Patients

Proglucagon peptide secretion profiles in type 2 diabetes before and after bariatric surgery: 1-year prospective study

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