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DOI: 10.2337/dc06-1549
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Original Research |
Incretin levels and effect are markedly enhanced one month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes
1Obesity Research Center and Bariatric Division, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1111 Amsterdam Avenue, New York, NY 10025
ABSTRACT
Objective:Limited data on patients undergoing Roux-en-Y gastric by pass surgery (RY-GBP) suggest that an improvement in insulin secretion after surgery occurs rapidly thus may not be wholly accounted for by weight loss. We hypothesized that in obese patients with type 2 diabetes mellitus (T2DM) the impaired levels and effect of incretins changed as a consequence of RY-GBP.
Research Design and Methods:Incretin (GIP and GLP-1) levels and their effect on insulin secretion were measured before and 1 month after RY-GBP in eight obese women with T2DM and in seven obese non-diabetic controls. The incretin effect was measured as the difference in insulin secretion (area under the curve, AUC) in response to oral glucose tolerance test (OGTT) and to an isoglycemic IV glucose test (isoG IVGT).
Results:Fasting and stimulated levels of GLP-1 and GIP were not different between Controls and Patients with T2DM before the surgery. One month after RY-GBP, body weight decreased by 9.2±7.0 kg, oral glucose-stimulated GLP-1 (AUC) and GIP peak levels increased significantly by 4368±1418 pM.L-1.min-1 (p<0.0001) and 131±85 pg/ml (p=0.007) respectively. The blunted incretin effect markedly increased from 7.6±28.7 to 42.5±11.3% (p=0.005) after RY-GBP, time at which it was not different from the Controls (53.6±23.5%, p=0.284).
Conclusions:These data suggest that early after RY-GBP, the greater GLP-1 and GIP release could be potential mediators of improved insulin secretion.
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