Abstract | BACKGROUND:
Bariatric surgery is the most effective treatment for the reduction of weight and resolution of type 2 diabetes mellitus (T2 DM). The objective of this study was to longitudinally assess hormonal and tissue responses after RYGB. METHODS: Eight patients (5 with T2 DM) were studied before and after RYGB. A standardized test meal (STM) was administered before and at 1, 3, 6, 9, 12, and 15 months. Separately, a 2-hour hyperinsulinemic-euglycemic clamp (E-clamp) and a 2-hour hyperglycemic clamp (H-clamp) were performed before and at 1, 3, 6, and 12 months. Glucagon-like peptide-1 (GLP-1) was infused during the last hour of the H-clamp. Body composition was assessed with DXA methodology. RESULTS: Enrollment body mass index was 49±3 kg/m(2) (X±SE). STM glucose and insulin responses were normalized by 3 and 6 months. GLP-1 level increased dramatically at 1, 3, and 6 months, normalizing by 12 and 15 months. Insulin sensitivity (M of E-clamp) increased progressively at 3-12 months as fat mass decreased. The insulin response to glucose alone fell progressively over 12 months but the glucose clearance/metabolism (M of H-clamp) did not change significantly until 12 months. In response to GLP-1 infusion, insulin levels fell progressively throughout the 12 months. CONCLUSION: The early hypersecretion of GLP-1 leads to hyperinsulinemia and early normalization of glucose levels. The GLP-1 response normalizes within 1 year after surgery. Enhanced peripheral tissue sensitivity to insulin starts at 3 months and is associated with fat mass loss. β-cell sensitivity improves at 12 months and after the loss of ≈33% of excess weight. There is a tightly controlled feedback loop between peripheral tissue sensitivity and β-cell and L-cell (GLP-1) responses.
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Authors | Dariush Elahi, Panagis Galiatsatos, Atoosa Rabiee, Rocio Salas-Carrillo, Amin Vakilipour, Olga D Carlson, Franca S Angeli, Richard P Shannon, Josephine M Egan, Dana K Andersen |
Journal | Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
(Surg Obes Relat Dis)
2014 Nov-Dec
Vol. 10
Issue 6
Pg. 1028-39
ISSN: 1878-7533 [Electronic] United States |
PMID | 25443077
(Publication Type: Journal Article, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2014 American Society for Bariatric Surgery. All rights reserved. |
Chemical References |
- Biomarkers
- Blood Glucose
- C-Peptide
- Insulin
- Glucagon-Like Peptide 1
- Glucagon
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Topics |
- Absorptiometry, Photon
- Biomarkers
(blood)
- Blood Glucose
(analysis)
- Body Composition
- Body Mass Index
- C-Peptide
(blood)
- Diabetes Mellitus, Type 2
(prevention & control)
- Enzyme-Linked Immunosorbent Assay
- Female
- Gastric Bypass
(methods)
- Glucagon
(blood)
- Glucagon-Like Peptide 1
(administration & dosage, blood)
- Glucose Clamp Technique
- Humans
- Insulin
(blood)
- Male
- Middle Aged
- Obesity, Morbid
(surgery)
- Weight Loss
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