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Improved glucose metabolism after gastric bypass: evolution of the paradigm

Artikel i vetenskaplig tidskrift
Författare D. J. Pournaras
J. Nygren
E. Hagstrom-Toft
P. Arner
Carel W le Roux
A. Thorell
Publicerad i Surgery for Obesity and Related Diseases
Volym 12
Nummer/häfte 8
Sidor 1457-1465
ISSN 1550-7289
Publiceringsår 2016
Publicerad vid Institutionen för kliniska vetenskaper, sektionen för kirurgi och kirurgisk gastroforskning, Avdelningen för gastrokirurgisk forskning och utbildning
Sidor 1457-1465
Språk English
Länkar dx.doi.org/10.1016/j.soard.2016.03....
Ämnesord Diabetes mellitus type 2, Obesity, Insulin resistance, Glucose clamp technique, Bariatric surgery, Gastric bypass, Randomized controlled trial, beta-cell function, substrate oxidation rates, low-calorie diet, weight-loss, insulin sensitivity, bariatric surgery, medical therapy, obese-patients, resistance, management, Surgery
Ämneskategorier Gastroenterologi

Sammanfattning

Background: Glucose metabolism is improved in patients with type 2 diabetes after Roux-en-Y gastric bypass (RYGB). Objectives: To quantify the relative contribution of calorie restriction, rerouting of nutrients, and adipose tissue reduction. Methods: Fifteen diabetic patients, (47 +/- 9 yr, body mass index 41.3 +/- 4.2 kg/m(2)) were randomized to a 2-week very low-calorie diet (VLCD) regimen or normal diet before RYGB. A euglycemic-hyperinsulinemic clamp, indirect calorimetry, and a standard meal test were performed prediet, postdiet (preoperatively), and 2 weeks and 12 months postoperatively. The primary outcome was whole-body insulin sensitivity (M) measured with the clamp 2 weeks postoperatively. Results: In the VLCD group, after 2 weeks of calorie restriction, M improved (2.9 +/- 1.3 to 4.2 +/- 1.1 mg/kg/min, P = .005) with no further change at 2 weeks postoperatively. In the normal diet group 2 weeks postoperatively, M was similar to the VLCD group (4.7 +/- 1.7 versus 4.2 +/- 1.1, P = .61). One year postoperatively, M improved further in both groups. The improvement in insulin-stimulated glucose uptake after VLCD and RYGB was entirely accounted for by nonoxidative glucose disposal (NOGD), whereas weight loss at 1 year postoperatively was associated with an increase in NOGD and glucose oxidation. Postprandial glucose improved after VLCD (P < .05) and even more 2 weeks after RYGB (P < .05) with no further change after 1 year. Conclusion: Improved whole-body insulin sensitivity and postprandial glucose response occur early after RYGB. Low calorie intake and rerouting of nutrients contribute through distinct mechanisms. Weight loss contributes by increasing whole-body insulin sensitivity, including glucose oxidation and NOGD. These data suggest that the combination of different mechanisms is what makes RYGB an effective intervention for type 2 diabetes. (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.

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