TY - JOUR
T1 - Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass
AU - Bojsen-Møller, Kirstine N
AU - Dirksen, Carsten
AU - Jørgensen, Nils Bruun
AU - Jacobsen, Siv Hesse
AU - Serup, Annette Karen Lundbeck
AU - Albers, Peter Hjorth
AU - Hansen, Dorte L
AU - Worm, Dorte
AU - Naver, Lars
AU - Kristiansen, Viggo B
AU - Wojtaszewski, Jørgen
AU - Kiens, Bente
AU - Holst, Jens Juul
AU - Richter, Erik A.
AU - Madsbad, Sten
N1 - CURIS 2014 NEXS 121
PY - 2014
Y1 - 2014
N2 - Roux-en-Y gastric bypass (RYGB) improves glycemic control within days after surgery, and changes in insulin sensitivity and beta-cell function are likely to be involved. We studied 10 obese patients with type 2 diabetes and 10 obese glucose tolerant subjects before, 1 week, 3 months and 1 year after RYGB. Participants were included after a preoperative diet induced total weight loss of -9.2±1.2%. Hepatic and peripheral insulin sensitivity were assessed using the hyperinsulinemic euglycemic clamp combined with glucose tracer technique and beta-cell function evaluated in response to an intravenous glucose-glucagon challenge as well as an oral glucose load. Already within 1 week, RYGB reduced basal glucose production, improved basal hepatic insulin sensitivity and increased insulin clearance highlighting the liver as an important organ responsible for the early effects on glucose metabolism after surgery. Insulin mediated glucose disposal and suppression of fatty acids did not improve immediately after surgery but increased at 3 months and 1 year likely related to the reduction in body weight. Insulin secretion increased after RYGB, but only in patients with type 2 diabetes and only in response to oral glucose, underscoring the importance of the changed gut anatomy.
AB - Roux-en-Y gastric bypass (RYGB) improves glycemic control within days after surgery, and changes in insulin sensitivity and beta-cell function are likely to be involved. We studied 10 obese patients with type 2 diabetes and 10 obese glucose tolerant subjects before, 1 week, 3 months and 1 year after RYGB. Participants were included after a preoperative diet induced total weight loss of -9.2±1.2%. Hepatic and peripheral insulin sensitivity were assessed using the hyperinsulinemic euglycemic clamp combined with glucose tracer technique and beta-cell function evaluated in response to an intravenous glucose-glucagon challenge as well as an oral glucose load. Already within 1 week, RYGB reduced basal glucose production, improved basal hepatic insulin sensitivity and increased insulin clearance highlighting the liver as an important organ responsible for the early effects on glucose metabolism after surgery. Insulin mediated glucose disposal and suppression of fatty acids did not improve immediately after surgery but increased at 3 months and 1 year likely related to the reduction in body weight. Insulin secretion increased after RYGB, but only in patients with type 2 diabetes and only in response to oral glucose, underscoring the importance of the changed gut anatomy.
U2 - 10.2337/db13-1307
DO - 10.2337/db13-1307
M3 - Journal article
C2 - 24241533
VL - 63
SP - 1725
EP - 1737
JO - Diabetes
JF - Diabetes
SN - 0012-1797
IS - 5
ER -