Rise of Oxyntomodulin in Response to Oral Glucose after Gastric Bypass Surgery in Patients with Type 2 Diabetes

Laferrère, Blandine; Swerdlow, Nicholas J.; Bawa, Baani; Arias, Sara; Bose, Mousumi; Oliván, Blanca; Teixeira, Júlio; McGinty, James; Rother, Kristina I.

doi:10.1210/jc.2009-2767

Cited by 117 publications

(62 citation statements)

References 19 publications

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“…[33][34][35] RYGBP surgical procedure involves the creation of a small gastric pouch (~30 ml) and a gastrojejunal anastomosis, resulting in the shunting of the larger part of the stomach, pylorus, duodenum and upper jejunum from ingested food. Gastric emptying of liquid is accelerated after RYGBP 33,36-38 and GLP-1 peak levels correlate positively with measures of gastric pouch emptying.…”

Section: Rygbp Alters Incretin Physiology Rygbp Enhances Incretin Relmentioning

confidence: 99%

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: Rygbp Alters Incretin Physiology Rygbp Enhances Incretin Relmentioning

confidence: 99%

Bariatric surgery and obesity: influence on the incretins

Laferrère

2016

Int J Obes Supp

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“…Like GLP-1, PYY is released from the intestinal L cells and levels of PPY are elevated postprandially after RYGB [13,45,50,63,64]. Levels of oxyntomodulin, another L cell product, have been reported to be elevated postoperatively [65], but the reported concentrations of oxyntomodulin were much higher than those of other L cell products (glicentin, GLP-1 and GLP-2), throwing doubt on the accuracy of the assays, given that oxyntomodulin is a product of the intestinal processing of proglucagon [66]. Nevertheless, significantly increased postprandial levels of enteroglucagon have been found after RYGB [14], 30-40% of which may be oxyntomodulin.…”

Section: Gut Hormones and Rygbmentioning

confidence: 99%

Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass

et al. 2012

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Roux-en-Y gastric bypass (RYGB) greatly improves glycaemic control in morbidly obese patients with type 2 diabetes, in many even before significant weight loss. Understanding the responsible mechanisms may contribute to our knowledge of the pathophysiology of type 2 diabetes and help identify new drug targets or improve surgical techniques. This review summarises the present knowledge based on pathophysiological studies published during the last decade. Taken together, two main mechanisms seem to be responsible for the early improvement in glycaemic control after RYGB: (1) an increase in hepatic insulin sensitivity induced, at least in part, by energy restriction and (2) improved beta cell function associated with an exaggerated postprandial glucagon-like peptide 1 secretion owing to the altered transit of nutrients. Later a weight loss induced improvement in peripheral insulin sensitivity follows.

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“…After RYGB, there is an early weight-independent increase in glucose-stimulated oxyntomodulin level, another important incretin originating in L-cells (Box 1), which strongly correlates with GLP-1 and PYY, suggesting concordant L-cell secretion (102). To date there has been no assessment of whether this effect persists.…”

Section: Mechanisms Of Weight Loss After Rygbmentioning

confidence: 99%

Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: understanding weight loss and improvements in type 2 diabetes after bariatric surgery

Scott

Batterham

2011

American Journal of Physiology-Regulatory, Integrative and Comp

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Obesity increases the likelihood of diseases like type 2 diabetes (T2D), heart disease, and cancer, and is one of the most serious public health problems of this century. In contrast to ineffectual prevention strategies, lifestyle modifications, and pharmacological therapies, bariatric surgery is a very effective treatment for morbid obesity and also markedly improves associated comorbidities like T2D. However, weight loss and resolution of T2D after bariatric surgery is heterogeneous and specific to type of bariatric procedure performed. Conventional mechanisms like intestinal malabsorption and gastric restriction do not fully explain this, and potent changes in appetite and the enteroinsular axis, as a result of anatomical reorganization and altered hormonal, neuronal, and nutrient signaling, are the portended cause. Uniquely these signaling changes appear to override vigorous homeostatic defenses of stable body weight and compelling self-gratifying motivations to eat and to reverse defects in beta-cell function and insulin sensitivity. Here we review mechanisms of weight loss and T2D resolution after Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy bariatric surgery, two markedly different procedures with robust clinical outcomes.

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Rise of Oxyntomodulin in Response to Oral Glucose after Gastric Bypass Surgery in Patients with Type 2 Diabetes

Cited by 117 publications

References 19 publications

Bariatric surgery and obesity: influence on the incretins

Bariatric surgery and obesity: influence on the incretins

Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass

Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: understanding weight loss and improvements in type 2 diabetes after bariatric surgery

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