Comparable early changes in gastrointestinal hormones after sleeve gastrectomy and Roux-En-Y gastric bypass surgery for morbidly obese type 2 diabetic subjects

• Published in: Surgical endoscopy Vol. 26; no. 8; pp. 2231 - 2239
• Main Authors: Romero, Fabiola, Nicolau, Joana, Flores, Lílliam, Casamitjana, Roser, Ibarzabal, Ainitze, Lacy, Antonio, Vidal, Josep
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.08.2012; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Area Under Curve; Biological and medical sciences; Blood Glucose - metabolism; Body mass index; Case-Control Studies; Diabetes; Diabetes Mellitus, Type 2 - blood; Female; Gastrectomy - methods; Gastric Bypass; Gastroenterology; Gastrointestinal Hormones - metabolism; Gastrointestinal surgery; General aspects; Glucagon; Glucagon - metabolism; Glucose; Gynecology; Heart surgery; Hepatology; Homeostasis; Hormones; Humans; Insulin; Insulin - metabolism; Insulin Secretion; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic diseases; Middle Aged; Obesity; Obesity, Morbid - blood; Obesity, Morbid - surgery; Polypeptides; Proctology; Prospective Studies; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Spain; GLP-1; Glucagon; GLP-2; Gastric bypass; GIP; Sleeve gastrectomy; Endocrinopathy; Type 2 diabetes; Pancreatic hormone; Hyperglycemic substances; Peptide hormone; Roux en Y loop; Sleeve; Gastrointestinal; Nutritional status; Glucagon · Sleeve gastrectomy; Human; Endoscopic surgery; Stomach; Obesity; Digestive system; Nutrition disorder; Metabolic diseases; Gastrectomy; Medicine; Treatment
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-012-2166-y

Background Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) are associated with similar type 2 diabetes mellitus (T2DM) resolution rates for morbidly obese subjects. However, the mechanisms underlying the resolution of T2DM after SG have not been clarified to date. This study aimed to compare the early changes in gastrointestinal hormones involved in insulin and glucagon secretion in morbidly obese T2DM subjects undergoing SG or RYGBP. Methods This prospective study investigated 12 subjects with T2DM who had undergone SG ( n  = 6) or RYGBP ( n  = 6). Five body mass index (BMI)-matched obese non-diabetic subjects and five BMI-matched obese diabetic subjects served as control subjects. Glucose, insulin, glucagon, glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and GLP-2 were determined after a standardized mixed liquid meal before surgery and 6 weeks afterward. Results After 6 weeks, five of the six subjects in each surgical group presented with T2DM remission, although the area under the curve (AUC) 0–120 of glucose was greater than that of the non-diabetic control subjects ( P  < 0.01). Postsurgically, the indices of insulin and glucagon secretion were comparable between the two surgical groups. The AUC 0–120 of GLP-1 ( P  < 0.05) and GLP-2 ( P  < 0.05) was significantly and comparably enlarged after SG and RYGB. The postsurgical GIP response was significantly associated with the glucagon response throughout the meal test (ρ = 0.747; P  < 0.01). Conclusions The data show that in a cohort of morbidly obese T2DM subjects, SG and RYGBP are associated with an early improvement in glucose tolerance, similar changes in insulin and glucagon secretion, and a similar GLP-1, GIP, and GLP-2 response to a standardized mixed liquid meal.