Significant Changes in Blood Pressure, Glucose, and Lipids with Gastric Bypass Surgery

Cowan, George S M; Buffington, Cynthia

doi:10.1007/s002689900504

Cited by 126 publications

(56 citation statements)

References 55 publications

(74 reference statements)

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“…Our results confirm the findings of previous studies showing the control of diabetes in morbidly obese patients following BPD with RYGBP (9,(11)(12)(13)(14). This beneficial effect was evident from the early postoperative period, despite the presence of morbid obesity.…”

Section: Discussionsupporting

confidence: 82%

Restoration of Euglycemia and Normal Acute Insulin Response to Glucose in Obese Subjects With Type 2 Diabetes Following Bariatric Surgery

et al. 2003

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Insulin resistance and loss of glucose-stimulated acute insulin response (AIR) are the two major and earliest defects in the course of type 2 diabetes. We investigated whether weight loss after bariatric surgery in patients with morbid obesity and type 2 diabetes could restore euglycemia and normal AIR to an intravenous glucose tolerance test (IVGTT). We studied 25 morbidly obese patients-12 with type 2 diabetes, 5 with impaired glucose tolerance, and 8 with normal glucose tolerance (NGT)-before and after a biliopancreatic diversion (BPD) with Roux-en-Y gastric bypass (RYGBP). Twelve individuals with normal BMI served as control subjects. Twelve months after surgery, in the diabetes group, BMI decreased from 53.2 ؎ 2.0 to 29.2 ؎ 1.7 kg/m 2 , fasting glucose decreased from 9.5 ؎ 0.83 to 4.5 ؎ 0.13 mmol/l, and fasting insulin decreased from 168.4 ؎ 25.9 to 37.7 ؎ 4.4 pmol/l (mean ؎ SE; P < 0.001). AIR, the mean of insulin concentration at 2, 3, and 5 min over basal in the IVGTT, increased by 770 and 935% at 3 and 12 months after surgery, respectively (from 24.0 ؎ 22.7 to 209 ؎ 43.4 and 248 ؎ 33.1 pmol/l, respectively; P < 0,001). Conversely, in the NGT group, the AIR decreased by 40.5% (from 660 ؎ 60 to 393 ؎ 93 pmol/l; P ‫؍‬ 0.027) 12 months after surgery. BPD with RYGBP performed in morbidly obese patients with type 2 diabetes leads to significant weight loss, euglycemia, and normal insulin sensitivity; but most importantly, it restores a normal ␤-cell AIR to glucose and a normal relationship of AIR to insulin sensitivity. This is the first study to demonstrate that the lost glucose-induced AIR in patients with type 2 diabetes of mild or moderate severity is a reversible abnormality.

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Section: Discussionsupporting

confidence: 82%

Restoration of Euglycemia and Normal Acute Insulin Response to Glucose in Obese Subjects With Type 2 Diabetes Following Bariatric Surgery

et al. 2003

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“…In fact, type 2 diabetes is usually considered a relentless and progressive disease. This knowledge is now being challenged by a growing body of evidence that remission of diabetes, that is, long-term restoration of normal glycemia and glycated hemoglobin levels without medications, can often be achieved after bariatric surgery (2)(3)(4)(5). Return to euglycemia and normal insulin levels are observed within days after surgery (5), suggesting that weight loss alone cannot entirely explain why surgery improves diabetes.…”

Section: Diabetes Care 31 (Suppl 2):s290-s296 2008mentioning

confidence: 99%

Is Type 2 Diabetes an Operable Intestinal Disease?

2008

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Type 2 diabetes, which accounts for 90 -95% of all cases of diabetes, is a growing epidemic that places a severe burden on health care systems, especially in developing countries. Because of both the scale of the problem and the current epidemic growth of diabetes, it is a priority to find new approaches to better understand and treat this disease. Gastrointestinal surgery may provide new opportunities in the fight against diabetes. Conventional gastrointestinal operations for morbid obesity have been shown to dramatically improve type 2 diabetes, resulting in normal blood glucose and glycosylated hemoglobin levels, with discontinuation of all diabetes-related medications. Return to euglycemia and normal insulin levels are observed within days after surgery, suggesting that weight loss alone cannot entirely explain why surgery improves diabetes. Recent experimental studies point toward the rearrangement of gastrointestinal anatomy as a primary mediator of the surgical control of diabetes, suggesting a role of the small bowel in the pathophysiology of the disease. This article presents available evidence in support of the hypothesis that type 2 diabetes may be an operable disease characterized by a component of intestinal dysfunction.

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“…24,25 Several series show that RYGB normalizes hyperglycemia, 3,26,27 restores insulin sensitivity, 11,28 prevents progression from impaired glucose tolerance to diabetes, 29 and possibly reduces mortality from diabetes mellitus. 30 Most series report return to euglycemia and normal insulin within days after surgery, long before there is any significant weight loss, 3,27 and this suggests that the control of diabetes is probably mediated by changes in hormones secretion from the gastrointestinal tract.…”

Section: The Control Of Diabetes After Roux-en-y Gastric Bypassmentioning

confidence: 99%

The Early Effect of the Roux-en-Y Gastric Bypass on Hormones Involved in Body Weight Regulation and Glucose Metabolism

Rubino¹,

Gautier²,

Gentileschi³

et al. 2004

Annals of Surgery

577

372

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Objective: To evaluate the early effect of Roux-en-Y (RYGB) gastric bypass on hormones involved in body weight regulation and glucose metabolism. Significant Background Data: The RYGB is an effective bariatric procedure for which the mechanism of action has not been elucidated yet. Reports of hormonal changes after RYGB suggest a possible endocrine effect of the operation; however, it is unknown whether these changes are the cause or rather the effect of surgically induced weight loss. We speculated that if the mechanism of action of the RYGB involves an endocrine effect, then hormonal changes should occur early after surgery, prior to substantial body weight changes. Methods: Ten patients with a mean preoperative body mass index (BMI) of 46.2 kg/m 2 (40 -53 kg/m 2 ) underwent laparoscopic RYGB. Six patients had type 2 diabetes treated by oral hypoglycemic agents. Preoperatively and 3 weeks following surgery, all patients were tested for fasting glucose, insulin, glucagon, insulinlike growth factor 1 (IGF-1), leptin, gastric inhibitory polypeptide (GIP), glucagon-like peptide-1 (GLP-1), cholecystokinin (CCK), adrenocorticotropic hormone (ACTH), corticosterone, and neuropeptide Y (NPY). Results: Changes in mean BMI were rather minimal (43.2 kg/m 2 ; P ϭ not significant), but there was a significant decrease in blood glucose (P ϭ 0.005), insulin (P ϭ 0.02), IGF-1 (P Ͻ 0.05), leptin (P ϭ 0.001), and an increase in ACTH levels (P ϭ 0.01). The other hormones were not significantly changed by surgery. All the 6 diabetic patients had normal glucose and insulin levels and did not require medications after surgery. The RYGB reduced GIP levels in diabetic patients (P Ͻ 0.01), whereas no changes in GIP levels were found in nondiabetics. Conclusions: Roux-en-Y gastric bypass determines considerable hormonal changes before significant BMI changes take place. These results support the hypothesis of an endocrine effect as the possible mechanism of action of RYGB. S urgery represents the most effective therapeutic modality for morbid obesity.1,2 Interestingly, the Roux-en-Y gastric bypass (RYGB), a procedure that includes the creation of a small proximal gastric pouch and the bypass of the duodenum and proximal jejunum from the transit of food, not only determines permanent reduction of excess body weight, but also induces resolution of type 2 diabetes mellitus in more than 80% of morbidly obese patients. 3Body weight is the result of complex physiologic mechanisms that control food intake and energy expenditure. Regulation of body weight involves several systems such as the adipose tissue, 4 the hypothalamus, 5 and the adrenal glands, 6 which are linked by neural and hormonal signals. Recent investigations have identified several key molecules that regulate food intake, including ghrelin, neuropeptide Y (NPY), 7 and melanocortins 8 and have focused on the relationship between obesity and leptin levels. The effectiveness of gastric bypass in inducing remarkable weight loss and control of diabetes represents an "experimental mod...

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Significant Changes in Blood Pressure, Glucose, and Lipids with Gastric Bypass Surgery

Cited by 126 publications

References 55 publications

Restoration of Euglycemia and Normal Acute Insulin Response to Glucose in Obese Subjects With Type 2 Diabetes Following Bariatric Surgery

Restoration of Euglycemia and Normal Acute Insulin Response to Glucose in Obese Subjects With Type 2 Diabetes Following Bariatric Surgery

Is Type 2 Diabetes an Operable Intestinal Disease?

The Early Effect of the Roux-en-Y Gastric Bypass on Hormones Involved in Body Weight Regulation and Glucose Metabolism

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