Weight loss and incretin responsiveness improve glucose control independently after gastric bypass surgery

Bose, Mousumi; Teixeira, Júlio; Oliván, Blanca; Bawa, Baani; Arias, Sara; Machineni, Sriram; Pi‐Sunyer, F. Xavier; Scherer, Philipp E.; Laferrère, Blandine

doi:10.1111/j.1753-0407.2009.00064.x

Cited by 104 publications

(105 citation statements)

References 25 publications

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“…43 Whether this is true in humans is unknown. It is legitimate to hypothesize that the chronic and sustained elevation of postprandial GLP-1 after RYGBP 28,44 could have a long-term trophic effect on the human β-cells in vivo; however, this is unknown. However, there is little evidence that chronic use of GLP-1 analogs, in patients with type 2 diabetes, restores and/or prevents the deterioration of β-cell function.…”

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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“…In addition to the increase in incretins, adiponectin and leptin decrease due to weight loss after GBP, beta cell function improves and abnormally elevated proinsulin and amylin levels decrease in diabetic patients [21]. Moreover, more studies have shown changes in amino-acid metabolism after GBP.…”

Section: Discussionmentioning

confidence: 99%

“…Studies and reports have shown that 5 -20 years after GBP, there was a significant rise in the GLP-1 and GIP postprandial levels compared to nonoperated individuals [11,19,20]. Incretin level and effect, early phase insulin release during the Oral Glucose Tolerance Test (OGTT) and the insulinogenic index all are corrected promptly after GBP, while fasting glucose, fasting insulin, leptin or adiponectin improve due to weight loss in the first year post GBP [21].…”

Section: Discussionmentioning

confidence: 99%

The Role of Bariatric Surgery in the Treatment of Type 2 Diabetes in Morbidly Obese Patients

Shoman¹

2017

JDMDC

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Obesity is a worldwide chronic epidemic and is a strong predictor of mortality. Its prevalence continues to increase despite public health efforts of awareness. With the rise in obesity and specifically morbid obesity worldwide, there has been a pronounced increase in obesity related metabolic disorders such as type 2 diabetes mellitus, hyperlipidemia, hypertension and some others. Reduction in weight is very important to control diabetes and one of the only measures that may cure diabetes and reduce weight loss is bariatric surgery. Bariatric surgery results in weight loss and the resolution of diabetes. Studies have shown that the effect of surgical weight loss has a more pronounced effect than diet controlled weight loss. This occurs due to several metabolic changes that occur in the body. The levels of incretins significantly rise including the rise of glucagon like peptide-1 and glucose-dependent insulinotropic polypeptide. In addition, PYY 3-36 and oxyntomodulin also rise post-surgery. On the other hand, there are reductions in branched chain amino acids, aromatic amino-acids phenylalanine and tyrosine.

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“…The changes in the secretion of incretin hormones produced in the small intestine and their effects on insulin and glucagon production may be a mediator of the significant improvement in blood glucose levels after gastric bypass surgery, which would not show the same effects when compared to weight loss caused by diet or restrictive surgeries [19][20][21] .…”

Section: Discussionmentioning

confidence: 99%

“…These two incretins are responsible for approximately 50% of postprandial secretion of insulin 21,22 .…”

Section: Discussionmentioning

confidence: 99%

Biliopancreatic diversion with duodenojejunal exclusion associated with truncal vagotomy: a new proposal for type 2 diabetes mellitus treatment

Alleotti¹,

Palma²,

Pinto³

et al. 2012

Acta Cir. Bras.

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PURPOSE: To evaluate the effectiveness of the biliopancreatic diversion surgery with duodenojejunal exclusion in combination with truncal vagotomy in type 2 diabetes mellitus (T2DM) patients with overweight or class I or II obesity. METHODS: The study included ten patients with T2DM and class I or II obesity or overweight who were subjected to biliopancreatic diversion with duodenojejunal exclusion in combination with truncal vagotomy. The blood glucose levels during the pre- and postoperative periods were compared using the Friedman test. The significance level adopted was 5%. RESULTS: There were significant differences between preoperative and postoperative blood glucose levels at three months (p=0.01), six months (p=0.001) and 12 months (p=0.001). There was also a significant difference between one month postoperative blood glucose and six months postoperative blood glucose (p=0.01). Glycosylated hemoglobin levels decreased in 80% of patients, there was marked improvement in their lipid profiles, and the average BMI reduction was 7.0±1.5 kg/m² at 12 months after the surgery. CONCLUSION: In patients with type 2 diabetes mellitus associated with class I/II obesity or overweight, performing biliopancreatic diversion with duodenojejunal exclusion in combination with truncal vagotomy resulted in glycemic control, reduction of excess weight, and improvement of lipid profile 12 months after the surgery.

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Weight loss and incretin responsiveness improve glucose control independently after gastric bypass surgery

Cited by 104 publications

References 25 publications

Bariatric surgery and obesity: influence on the incretins

Bariatric surgery and obesity: influence on the incretins

The Role of Bariatric Surgery in the Treatment of Type 2 Diabetes in Morbidly Obese Patients

Biliopancreatic diversion with duodenojejunal exclusion associated with truncal vagotomy: a new proposal for type 2 diabetes mellitus treatment

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