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- Title
Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes.
- Authors
Laferrère, Blandine; Teixeira, Julio; McGinty, James; Tran, Hao; Egger, Joseph R; Colarusso, Antonia; Kovack, Betty; Bawa, Baani; Koshy, Ninan; Lee, Hongchan; Yapp, Kimberly; Olivan, Blanca
- Abstract
<bold>Context: </bold>Gastric bypass surgery (GBP) results in rapid weight loss, improvement of type 2 diabetes (T2DM), and increase in incretins levels. Diet-induced weight loss also improves T2DM and may increase incretin levels.<bold>Objective: </bold>Our objective was to determine whether the magnitude of the change of the incretin levels and effect is greater after GBP compared with a low caloric diet, after equivalent weight loss.<bold>Design and Methods: </bold>Obese women with T2DM studied before and 1 month after GBP (n = 9), or after a diet-induced equivalent weight loss (n = 10), were included in the study. Patients from both groups were matched for age, body weight, body mass index, diabetes duration and control, and amount of weight loss.<bold>Setting: </bold>This outpatient study was conducted at the General Clinical Research Center.<bold>Main Outcome Measures: </bold>Glucose, insulin, proinsulin, glucagon, gastric inhibitory peptide (GIP), and glucagon-like peptide (GLP)-1 levels were measured after 50-g oral glucose. The incretin effect was measured as the difference in insulin levels in response to oral and to an isoglycemic iv glucose load.<bold>Results: </bold>At baseline, none of the outcome variables (fasting and stimulated values) were different between the GBP and diet groups. Total GLP-1 levels after oral glucose markedly increased six times (peak:17 +/- 6 to 112 +/- 54 pmol/liter; P < 0.001), and the incretin effect increased five times (9.4 +/- 27.5 to 44.8 +/- 12.7%; P < 0.001) after GBP, but not after diet. Postprandial glucose levels (P = 0.001) decreased more after GBP.<bold>Conclusions: </bold>These data suggest that early after GBP, the greater GLP-1 and GIP release and improvement of incretin effect are related not to weight loss but rather to the surgical procedure. This could be responsible for better diabetes outcome after GBP.
- Subjects
BLOOD sugar analysis; TYPE 2 diabetes treatment; OBESITY treatment; COMPARATIVE studies; GLUCAGON; RESEARCH methodology; INCRETINS; MEDICAL cooperation; TYPE 2 diabetes; OBESITY; REDUCING diets; RESEARCH; WEIGHT loss; GLUCAGON-like peptide 1; GASTRIC bypass; EVALUATION research
- Publication
Journal of Clinical Endocrinology & Metabolism, 2008, Vol 93, Issue 7, p2479
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2007-2851