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- Title
GLP-1 and GIP Levels and Effect Are Markedly Enhanced One Month After Roux-en-Y Gastric Bypass Surgery in Obese Patients with Type 2 Diabetes.
- Authors
Laferrere, Blandine; Tran, Hap C.; Yap, Kimberly P.; Heshka, Stanley; McGinty, James; Teixeira, Julio; Olivan, Blanca
- Abstract
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 the incretin hormones GIP and GLP-1 changed as a consequence of RY-GBP. GIP and GLP-1 levels and their effect on insulin secretion (incretin effect) 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 levels (area under the curve, AUC[sub 0-180min]) in response to oral glucose tolerance test (OGTT) and to an isoglycemic IV glucose test (isoG IVGT). Total GLP-1, insulin and C-peptide were measured by RIA, GIP by ELISA and glucose by the glucose oxidase method. Data are presented as mean ± SD. Statistical analyses were performed with SPSS 13.0. Eight obese women with T2DM of 20.1 ± 12.9 months duration, HbA1C 6.9 ± 0.7 %, were studied before and 1 month after RY-GBP. Patients' diabetes medications were discontinued 3 days prior to the baseline OGTT before the surgery. None of the patients were taking insulin, thiazolinedione or beta-blocker before RY-GBP or any diabetes medication after RY-GBP. Seven obese non-diabetic women were studied as controls, while on their regular diet, at stable weight, on no medications. Controls did not differ from patients in terms of age, body weight, BMI. 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[sup -1].min[sup 01] (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 R-YGBP, time at which it was not different from the Controls (53.6±23.5%, p=0.284). These data suggest that 1 month after RY-GBP, the greater GLP-1 and GIP stimulated release could be potential mediators of improved insulin secretion in patients with T2DM. Acknowledgment: This work was funded by the NIH DK67561, RR00645, DK-26687, ADA CRA 7-05-CR-18 ADA-Funded Research
- Subjects
GLUCAGON-like peptide 1; GASTRIC bypass; OVERWEIGHT persons; TYPE 2 diabetes; INSULIN; GLUCOSE tolerance tests
- Publication
Diabetes, 2007, Vol 56, pA374
- ISSN
0012-1797
- Publication type
Article