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Acute effects of gastric bypass versus gastric restrictive surgery on β-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes

International Journal of Obesity volume 34, pages 462–471 (2010)Cite this article

Abstract

Context:

Hyperglycemia resolves quickly after bariatric surgery, but the underlying mechanism and the most effective type of surgery remains unclear.

Objective:

To examine glucose metabolism and β-cell function in patients with type 2 diabetes mellitus (T2DM) after two types of bariatric intervention; Roux-en-Y gastric bypass (RYGB) and gastric restrictive (GR) surgery.

Design:

Prospective, nonrandomized, repeated-measures, 4-week, longitudinal clinical trial.

Patients:

In all, 16 T2DM patients (9 males and 7 females, 52±14 years, 47±9 kg m−2, HbA1c 7.2±1.1%) undergoing either RYGB (N=9) or GR (N=7) surgery.

Outcome measures:

Glucose, insulin secretion, insulin sensitivity at baseline, and 1 and 4 weeks post-surgery, using hyperglycemic clamps and C-peptide modeling kinetics; glucose, insulin secretion and gut-peptide responses to mixed meal tolerance test (MMTT) at baseline and 4 weeks post-surgery.

Results:

At 1 week post-surgery, both groups experienced a similar weight loss and reduction in fasting glucose (P<0.01). However, insulin sensitivity increased only after RYGB, (P<0.05). At 4 weeks post-surgery, weight loss remained similar for both groups, but fasting glucose was normalized only after RYGB (95±3 mg 100 ml−1). Insulin sensitivity improved after RYGB (P<0.01) and did not change with GR, whereas the disposition index remained unchanged after RYGB and increased 30% after GR (P=0.10). The MMTT elicited a robust increase in insulin secretion, glucagon-like peptide-1 (GLP-1) levels and β-cell sensitivity to glucose only after RYGB (P<0.05).

Conclusion:

RYGB provides a more rapid improvement in glucose regulation compared with GR. This improvement is accompanied by enhanced insulin sensitivity and β-cell responsiveness to glucose, in part because of an incretin effect.

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Acknowledgements

We are grateful to the nurses and technicians in the Cleveland Clinic, Clinical Research Unit for providing the skilled assistance that enabled the successful implementation of this study. This work was supported in part by National Institutes of Health, National Center for Research Resources (NCRR), Multidisciplinary Clinical Research Career Development Programs Grant 5K12RR023264 (SRK), National Institutes of Aging Award RO1 AG12834 (JPK), National Center for Research Resources, CTSA 1UL1RR024989 and by Ethicon Endo-Surgery (PRS, SRK). Grant support: NIH, NCRR, Multidisciplinary Clinical Research Career Development Programs Grant 5K12RR023264, National Center for Research Resources, CTSA 1UL1RR024989 and Ethicon Endo-Surgery. Disclosure statement: Dr Kashyap discloses relationships with Ethicon endo-surgery (research grants); Dr Schauer discloses relationships with Ethicon endo-surgery (research grants).

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Authors and Affiliations

  1. Endocrinology and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    S R Kashyap, S Daud, H Win, S Brethauer & P R Schauer

  2. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    K R Kelly & J P Kirwan

  3. Fondazione G Monasterio and Institute of Clinical Physiology, National Research Council, Pisa, Italy

    A Gastaldelli

  4. Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA

    J P Kirwan

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  1. S R Kashyap
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Correspondence to S R Kashyap.

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Supplementary Information accompanies the paper on International Journal of Obesity website (http://www.nature.com/ijo)

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Kashyap, S., Daud, S., Kelly, K. et al. Acute effects of gastric bypass versus gastric restrictive surgery on β-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes. Int J Obes 34, 462–471 (2010). https://doi.org/10.1038/ijo.2009.254

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