Weight loss and incretin responsiveness improve glucose control independently after gastric bypass surgery
Article first published online: 2 NOV 2009
© 2010 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd
Journal of Diabetes
Volume 2, Issue 1, pages 47–55, March 2010
How to Cite
BOSE, M., TEIXEIRA, J., OLIVAN, B., BAWA, B., ARIAS, S., MACHINENI, S., PI-SUNYER, F. X., SCHERER, P. E. and LAFERRÈRE, B. (2010), Weight loss and incretin responsiveness improve glucose control independently after gastric bypass surgery. Journal of Diabetes, 2: 47–55. doi: 10.1111/j.1753-0407.2009.00064.x
- Issue published online: 21 FEB 2010
- Article first published online: 2 NOV 2009
- Received 3 August 2009; revised 25 September 2009; accepted 9 October 2009.
- gastric bypass;
- glucagon-like peptide-1;
- glucose-dependent insulinotropic polypeptide;
Background: The aim of the present study was to determine the mechanisms underlying Type 2 diabetes remission after gastric bypass (GBP) surgery by characterizing the short- and long-term changes in hormonal determinants of blood glucose.
Methods: Eleven morbidly obese women with diabetes were studied before and 1, 6, and 12 months after GBP; eight non-diabetic morbidly obese women were used as controls. The incretin effect was measured as the difference in insulin levels in response to oral glucose and to an isoglycemic intravenous challenge. Outcome measures were glucose, insulin, C-peptide, proinsulin, amylin, glucagon, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide-1 (GLP-1) levels and the incretin effect on insulin secretion.
Results: The decrease in fasting glucose (r = 0.724) and insulin (r = 0.576) was associated with weight loss up to 12 months after GBP. In contrast, the blunted incretin effect (calculated at 22%) that improved at 1 month remained unchanged with further weight loss at 6 (52%) and 12 (52%) months. The blunted incretin (GLP-1 and GIP) levels, early phase insulin secretion, and other parameters of β-cell function (amylin, proinsulin/insulin) followed the same pattern, with rapid improvement at 1 month that remained unchanged at 1 year.
Conclusions: The data suggest that weight loss and incretins may contribute independently to improved glucose levels in the first year after GBP surgery.