Skip to main content

Advertisement

SpringerLink
Log in

Early Improvement in Glycemic Control After Bariatric Surgery and Its Relationships with Insulin, GLP-1, and Glucagon Secretion in Type 2 Diabetic Patients

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The surgical treatment of obesity ameliorates metabolic abnormalities in patients with type 2 diabetes. The objective of this study was to evaluate the early effects of Roux-en-Y gastric bypass (RYGB) on metabolic and hormonal parameters in patients with type 2 diabetes (T2DM).

Methods

Ten patients with T2DM (BMI, 39.7 ± 1.9) were evaluated before and 7, 30, and 90 days after RYGB. A meal test was performed, and plasma insulin, glucose, glucagon, and glucagon-like-peptide 1 (GLP-1) levels were measured at fasting and postprandially.

Results

Seven days after RYGB, a significant reduction was observed in HOMA-IR index from 7.8 ± 5.5 to 2.6 ± 1.7; p < 0.05 was associated with a nonsignificant reduction in body weight. The insulin and GLP-1 curves began to show a peak at 30 min after food ingestion, while there was a progressive decrease in glucagon and blood glucose levels throughout the meal test. Thirty and 90 days after RYGB, along with progressive weight loss, blood glucose and hormonal changes remained in the same direction and became more expressive with the post-meal insulin curve suggesting recovery of the first phase of insulin secretion and with the increase in insulinogenic index, denoting improvement in β-cell function. Furthermore, a positive correlation was found between changes in GLP-1 and insulin levels measured at 30 min after meal (r = 0.6; p = 0.000).

Conclusion

Our data suggest that the RYGB surgery, beyond weight loss, induces early beneficial hormonal changes which favor glycemic control in type 2 diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sjostrom L, Lindroos A, Peltonen M, et al. Lifestyle, diabetes and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.

    Article  PubMed  Google Scholar 

  2. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be most effective therapy for adult onset diabetes mellitus. Ann Surg. 1995;222(3):339–50. Discussion 350–52.

    Article  PubMed  CAS  Google Scholar 

  3. Pories WJ, MacDonald KG, Morgan EJ, et al. Surgical treatment of obesity and its effect on diabetes: 10-y follow-up. Am J Nutr. 1992;55(2 Suppl):582S–5S.

    CAS  Google Scholar 

  4. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84.

    PubMed  Google Scholar 

  5. Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239(1):1–11.

    Article  PubMed  Google Scholar 

  6. Rubino F, Schauer PR, Kaplan LM, et al. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med. 2010;61:393–411.

    Article  PubMed  CAS  Google Scholar 

  7. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. 2004;292(14):1724–37.

    CAS  Google Scholar 

  8. Jazet IM, Pijl H, Frölich M, et al. Two days of a very low calorie diet reduces endogenous glucose production in obese type 2 diabetic patients despite the withdrawal of blood glucose-lowering therapies including insulin. Metabolism. 2005;54(6):705–12.

    Article  PubMed  CAS  Google Scholar 

  9. Jazet IM, Ouwens DM, Schaart G, et al. Effect of a 2-day very low-energy diet on skeletal muscle insulin sensitivity in obese type 2 diabetic patients on insulin therapy. Metabolism. 2005;54(12):1669–78.

    Article  PubMed  CAS  Google Scholar 

  10. Isbell JM, Tamboli RA, Hansen EN, et al. The importance of caloric restriction in the early improvements in insulin sensitivity after roux-en-y gastric bypass surgery. Diabetes Care. 2010;33(7):1438–42.

    Article  PubMed  CAS  Google Scholar 

  11. Mithieux G, Misery P, Magnan C, et al. Portal sensing of intestinal gluconeogenesis is a mechanistic link in the diminution of food intake induced by diet protein. Cell Metab. 2005;2:321–9.

    Article  PubMed  CAS  Google Scholar 

  12. Mithieux G, Bady I, Gautier A, et al. Induction of control genes in intestinal gluconeogenesis is sequential during fasting and maximal in diabetes. Am J Physiol Endocrinol Metab. 2004;286:E370–5.

    Article  PubMed  CAS  Google Scholar 

  13. Mithieux G, Andrelli F, Magnan C. Intestinal gluconeogenesis: key signal of central control of energy and glucose homeostasis. Curr Opin Clin Nutr Metab Care. 2009;12:419–23.

    Article  PubMed  CAS  Google Scholar 

  14. Troy S, Soty M, Ribeiro L, et al. Intestinal gluconeogenesis is a key factor for early metabolic changes after gastric bypass but not after gastric lap-band in mice. Cell Metab. 2008;8:201–11.

    Article  PubMed  CAS  Google Scholar 

  15. Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244:741–9.

    Article  PubMed  Google Scholar 

  16. Hickey MS, Pories WJ, MacDonald Jr KG, et al. A new paradigm for type 2 diabetes mellitus: could it be a disease of the of foregut? Ann Surg. 1998;227:637–43. discussion 43–4.

    Article  PubMed  CAS  Google Scholar 

  17. Naslund E, Backman L, Holst JJ, et al. Importance of small bowel peptide for the improved glucose metabolism 20 years after jejunoileal bypass for obesity. Obes Surg. 1998;8:253–60.

    Article  PubMed  CAS  Google Scholar 

  18. Thaler JP, Cummings DE. Minireview: hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150(6):2518–25.

    Article  PubMed  CAS  Google Scholar 

  19. Kashyap SR, Daud S, Kelly KR, et al. Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes. Int J Obes (Lond). 2009;34(3):462–71.

    Article  Google Scholar 

  20. Le Roux CW, Aylwin SJ, Batterham RL, et al. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2006;243(1):108–14.

    Article  PubMed  Google Scholar 

  21. Holdstock C, Zethelius B, Sundbom M, et al. Postprandial changes in gut regulatory peptides in gastric bypass patients. Int J Obes. 2008;32(11):1640–6.

    Article  CAS  Google Scholar 

  22. Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93(7):2479–85.

    Article  PubMed  Google Scholar 

  23. Wang TT, Hu SY, Gao HD, et al. Ileal transposition controls diabetes as well as modified duodenal jejunal bypass with better lipid lowering in a nonobese rat model of type II diabetes by increasing GLP-1. Ann Surg. 2008;247(6):968–75.

    Article  PubMed  Google Scholar 

  24. Alam ML, Van der Schueren BJ, Ahren B, et al. Gastric bypass surgery, but not caloric restriction, decreases dipeptidyl peptidase-4 activity in obese patients with type 2 diabetes. Diabetes Obes Metab. 2011;13:378–81.

    Article  PubMed  CAS  Google Scholar 

  25. Laferrère B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care. 2007;30:1709–16.

    Article  PubMed  Google Scholar 

  26. Boden G. Free fatty acids—the link between obesity and insulin resistance. Endocr Pract. 2001;7(1):44–51.

    PubMed  CAS  Google Scholar 

  27. Ruan H, Lodish HF. Regulation of insulin sensitivity by adipose tissue-derived hormones and inflammatory cytokines. Curr Opin Lipidol. 2004;15(3):297–302.

    Article  PubMed  CAS  Google Scholar 

  28. Wajchenberg BL. Beta-cell failure in diabetes and preservation by clinical treatment. Endocr Rev. 2007;28(2):187–218.

    Article  PubMed  CAS  Google Scholar 

  29. Manfredini G, Ermini M, Scops L, et al. Internal biliary diversion improves glucose tolerance in the rat. Am J Physiol Gastrointest Liver Physiol. 1985;249:G519–27.

    CAS  Google Scholar 

  30. Patti ME et al. Serum bile acids are higher in humans with prior gastric bypass: potential contribution to improved glucose and lipid metabolism. Obesity. 2009;17:1671–7.

    Article  PubMed  CAS  Google Scholar 

  31. Wang PYT, Caspi L, Lam CKL, et al. Upper intestinal lipids trigger a gut–brain–liver axis to regulate glucose production. Nature. 2008;452:1012–6.

    Article  PubMed  CAS  Google Scholar 

  32. Lima MMO, Pareja JC, Alegre SM, et al. Acute effect of Roux-en-y gastric bypass on whole-body insulin sensitivity: a study with euglicemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(8):3871–5.

    Article  PubMed  CAS  Google Scholar 

  33. Furet JP, Kong LC, Tap J, et al. Differential adaptation of human gut microbiota to bariatric surgery-induced weight loss: links with metabolic and low-grade inflammation markers. Diabetes. 2010;59(12):3049–5.

    Article  Google Scholar 

Download references

Conflict of Interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo, Rua Leandro Dupret 365, CEP 04025011, Vila Clementino, São Paulo, Brazil

    Luciana Mela Umeda, Eliana A. Silva, Glaucia Carneiro & Maria Teresa Zanella

  2. Department of Surgery, Division of Gastroenterology, Universidade Federal São Paulo, Vila Clementino, São Paulo, Brazil

    Carlos H. Arasaki

  3. Department of Medicine, Division of Endocrinology, Universidade de Campinas, Campinas, São Paulo, Brazil

    Bruno Geloneze

Authors
  1. Luciana Mela Umeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eliana A. Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Glaucia Carneiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carlos H. Arasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bruno Geloneze
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Teresa Zanella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luciana Mela Umeda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Umeda, L.M., Silva, E.A., Carneiro, G. et al. Early Improvement in Glycemic Control After Bariatric Surgery and Its Relationships with Insulin, GLP-1, and Glucagon Secretion in Type 2 Diabetic Patients. OBES SURG 21, 896–901 (2011). https://doi.org/10.1007/s11695-011-0412-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-011-0412-3

Keywords

Search

Navigation