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GLP-1 and the long-term outcome of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery in morbidly obese subjects.
Ann Surg. 2013 May; 257(5):894-9.AnnS

Abstract

OBJECTIVE

To evaluate the association between glucagon-like peptide 1 (GLP-1) secretion and the long-term (>2 years) outcome of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGBP).

METHODS

Cross-sectional study in 18 T2DM morbidly obese subjects who underwent RYGBP but differed in the long-term outcome of T2DM (remission: G1, n = 6; relapse: G2, n = 6; lack of remission: G3: n = 6). Groups were matched for their sex, age, and body mass index. The GLP-1, glucose, C-peptide, and glucagon responses to a standardized test meal (STM) were evaluated. Insulin secretion and insulin sensitivity were estimated from the STM and by frequently sampling intravenous glucose tolerance test (FSIVGTT). Dual-energy X-ray absorptiometry was used to assess body composition.

RESULTS

Patients in G1 presented a lower area under the curve (AUC0-120) of glucose in response to the STM as compared with G2, and G3 (P < 0.01). In contrast, the AUC0-120 of GLP-1 (P = 0.884) and glucagon (P = 0.630) did not differ significantly among the 3 groups. Indices of insulin secretion adjusted by the prevailing insulin sensitivity derived from STM and FSIVGTT, demonstrated larger β-cell function in subjects in G1 as compared with G2 or G3 (Disposition Index-STM, P = 0.005; DI-FSIVGTT, P = 0.006). Body composition and inflammatory markers did not differ significantly among the 3 study groups.

CONCLUSIONS

Our data show that in subjects with T2DM an enhanced GLP-1 response to meal intake is not sufficient to maintain normal glucose tolerance in the long term after RYGBP. Our data suggest that β-cell function is a key determinant of the long-term remission of T2DM after this bariatric surgery technique.

Authors+Show Affiliations

Obesity Unit, Hospital Clinic Universitari, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23579541

Citation

Jiménez, Amanda, et al. "GLP-1 and the Long-term Outcome of Type 2 Diabetes Mellitus After Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Subjects." Annals of Surgery, vol. 257, no. 5, 2013, pp. 894-9.
Jiménez A, Casamitjana R, Flores L, et al. GLP-1 and the long-term outcome of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery in morbidly obese subjects. Ann Surg. 2013;257(5):894-9.
Jiménez, A., Casamitjana, R., Flores, L., Delgado, S., Lacy, A., & Vidal, J. (2013). GLP-1 and the long-term outcome of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery in morbidly obese subjects. Annals of Surgery, 257(5), 894-9. https://doi.org/10.1097/SLA.0b013e31826b8603
Jiménez A, et al. GLP-1 and the Long-term Outcome of Type 2 Diabetes Mellitus After Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Subjects. Ann Surg. 2013;257(5):894-9. PubMed PMID: 23579541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - GLP-1 and the long-term outcome of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery in morbidly obese subjects. AU - Jiménez,Amanda, AU - Casamitjana,Roser, AU - Flores,Lílliam, AU - Delgado,Salvadora, AU - Lacy,Antonio, AU - Vidal,Josep, PY - 2013/4/13/entrez PY - 2013/4/13/pubmed PY - 2013/6/5/medline SP - 894 EP - 9 JF - Annals of surgery JO - Ann Surg VL - 257 IS - 5 N2 - OBJECTIVE: To evaluate the association between glucagon-like peptide 1 (GLP-1) secretion and the long-term (>2 years) outcome of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGBP). METHODS: Cross-sectional study in 18 T2DM morbidly obese subjects who underwent RYGBP but differed in the long-term outcome of T2DM (remission: G1, n = 6; relapse: G2, n = 6; lack of remission: G3: n = 6). Groups were matched for their sex, age, and body mass index. The GLP-1, glucose, C-peptide, and glucagon responses to a standardized test meal (STM) were evaluated. Insulin secretion and insulin sensitivity were estimated from the STM and by frequently sampling intravenous glucose tolerance test (FSIVGTT). Dual-energy X-ray absorptiometry was used to assess body composition. RESULTS: Patients in G1 presented a lower area under the curve (AUC0-120) of glucose in response to the STM as compared with G2, and G3 (P < 0.01). In contrast, the AUC0-120 of GLP-1 (P = 0.884) and glucagon (P = 0.630) did not differ significantly among the 3 groups. Indices of insulin secretion adjusted by the prevailing insulin sensitivity derived from STM and FSIVGTT, demonstrated larger β-cell function in subjects in G1 as compared with G2 or G3 (Disposition Index-STM, P = 0.005; DI-FSIVGTT, P = 0.006). Body composition and inflammatory markers did not differ significantly among the 3 study groups. CONCLUSIONS: Our data show that in subjects with T2DM an enhanced GLP-1 response to meal intake is not sufficient to maintain normal glucose tolerance in the long term after RYGBP. Our data suggest that β-cell function is a key determinant of the long-term remission of T2DM after this bariatric surgery technique. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/23579541/GLP_1_and_the_long_term_outcome_of_type_2_diabetes_mellitus_after_Roux_en_Y_gastric_bypass_surgery_in_morbidly_obese_subjects_ L2 - https://Insights.ovid.com/pubmed?pmid=23579541 DB - PRIME DP - Unbound Medicine ER -