Incretin Levels and Effect Are Markedly Enhanced 1 Month After Roux-en-Y Gastric Bypass Surgery in Obese Patients With Type 2 Diabetes

  1. Blandine Laferrère, MD1,
  2. Stanley Heshka, PHD1,
  3. Krystle Wang, BS1,
  4. Yasmin Khan, BS1,
  5. James McGinty, MD2,
  6. Julio Teixeira, MD2,
  7. Allison B. Hart, BS1 and
  8. Blanca Olivan, MD1
  1. 1Obesity Research Center, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York
  2. 2Bariatric Division, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York
  1. Address correspondence and reprint requests to Blandine Laferrère, MD, Obesity Research Center, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1111 Amsterdam Ave., New York, NY 10025. E-mail: bbl14{at}columbia.edu

Abstract

OBJECTIVE— Limited data on patients undergoing Roux-en-Y gastric bypass surgery (RY-GBP) suggest that an improvement in insulin secretion after surgery occurs rapidly and thus may not be wholly accounted for by weight loss. We hypothesized that in obese patients with type 2 diabetes the impaired levels and effect of incretins changed as a consequence of RY-GBP.

RESEARCH DESIGN AND METHODS— Incretin (gastric inhibitory peptide [GIP] and glucagon-like peptide-1 [GLP-1]) levels and their effect on insulin secretion were measured before and 1 month after RY-GBP in eight obese women with type 2 diabetes and in seven obese nondiabetic control subjects. The incretin effect was measured as the difference in insulin secretion (area under the curve [AUC]) in response to an oral glucose tolerance test (OGTT) and to an isoglycemic intravenous glucose test.

RESULTS— Fasting and stimulated levels of GLP-1 and GIP were not different between control subjects and patients with type 2 diabetes 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 24.3 ± 7.9 pmol · 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, at which it time was not different from that for the control subjects (53.6 ± 23.5%, P = 0.284).

CONCLUSIONS— These data suggest that early after RY-GBP, greater GLP-1 and GIP release could be a potential mediator of improved insulin secretion.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 6 April 2007. DOI: 10.2337/dc06-1549.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted March 18, 2007.
    • Received July 24, 2006.
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  1. Diabetes Care vol. 30 no. 7 1709-1716
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