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- Title
Proinsulin associates with poor β‐cell function, glucose‐dependent insulinotropic peptide, and insulin resistance in persistent type 2 diabetes after Roux‐en‐Y gastric bypass in humans.
- Authors
Patel, Kapila; Levesque, Kiarra; Mark, Victoria; Pierini, Esmeralda; Rojas, Betsy; Ahlers, Michael; Shah, Ankit; Laferrère, Blandine
- Abstract
Background: The determinants of type 2 diabetes (T2D) remission and/or relapse after gastric bypass (RYGB) remain fully unknown. This study characterized β‐ and α‐cell function, in cretin hormone release and insulin sensitivity in individuals with (remitters) or without (non‐remitters) diabetes remission after RYGB. Methods: This is a cross‐sectional study of two distinct cohorts of individuals with or without diabetes remission at least 2 years after RYGB. Each individual underwent‐either an oral glucose (remitters) or a mixed meal (non‐remitters) test; glucose, proinsulin, insulin, C‐peptide, glucagon, incretins and leptin were measured. Results: Compared to remitters (n = 23), non‐remitters (n = 31) were older (mean [±SD] age 56.1 ± 8.2 vs. 46.0 ± 8.9 years, P < 0.001), had longer diabetes duration (13.1 ± 10.1 vs. 2.2 ± 2.4 years, P < 0.001), were further out from the surgery (5.6 ± 3.3 vs. 3.5 ± 1.7 years, P < 0.01), were more insulin resistant (HOMA‐IR 4.01 ± 3.65 vs. 2.08 ± 1.22, P < 0.001), but did not differ for body weight. As predicted, remitters had higher β‐cell glucose sensitivity (1.95 ± 1.23 vs. 0.86 ± 0.55 pmol/kg/min/mmol, P < 0.001) and disposition index (1.55 ± 1.75 vs 0.33 ± 0.27, P = 0.003), compared to non‐remitters, who showed non‐suppressibility of glucagon during the oral challenge (time × group P = 0.001). Higher proinsulin (16.55 ± 10.45 vs. 6.62 ± 3.50 PM, P < 0.0001), and proinsulin: C‐peptide (40.83 ± 29.43 vs. 17.13 ± 7.16, P < 0.001) were strongly associated with non‐remission status, while differences in incretins between remitters and non‐remitters were minimal. Conclusions: Individual without diabetes remission after gastric bypass have poorer β‐cell response and lesser suppression of glucagon to an oral challenge; body weight and incretins differ minimally according to remission status.
- Subjects
TYPE 2 diabetes; GASTRIC bypass; GASTRIC inhibitory polypeptide; PROINSULIN; INSULIN resistance; AMBULATORY surgery
- Publication
Journal of Diabetes, 2020, Vol 12, Issue 1, p77
- ISSN
1753-0393
- Publication type
Article
- DOI
10.1111/1753-0407.12964