Roux-en-Y gastric bypass surgery reduces Type 2 diabetes symptoms in severely obese
MedWire News: Severely obese patients who undergo Roux-en-Y gastric bypass (RYGB) surgery have significantly improved insulin sensitivity and beta cell responsiveness to glucose compared with those who have gastric restrictive (GR) surgery, show study results.
Patients who undergo bariatric surgery to combat severe obesity are known to experience improvements in glucose metabolism, but the mechanism underlying this, and the most effective form of surgery, are unclear.
Sangeeta Kashyap (Cleveland Clinic Foundation, Ohio, USA) and team followed up 16 severely obese (mean body mass index [BMI]=47 kg/m2) Type 2 diabetes patients who underwent RYGB (n=9) or GR (n=7) surgery. The mean age of the patients was 52 years and the average preoperative glycated hemoglobin was 7.2%.
The researchers measured glucose, insulin secretion, and insulin sensitivity at baseline, and at 1 and 4 weeks after the operation.
They found that at 1 week post surgery both groups had lost 7–8% of their body weight and fasting plasma glucose had decreased by around 20%. Insulin sensitivity was only increased significantly at 1 week in the RYGB group, however.
At 4 weeks, weight loss was similar in both groups, at around 10%. Plasma glucose was normalized (95 mg/dl) only in the RYGB group. Similar to measures taken at 1 week, insulin sensitivity was significantly increased from baseline in the RYGB, but not the GR, group.
A mixed meal tolerance test carried out at 4 weeks demonstrated a significant increase in insulin secretion, glucagon-like peptide-1 levels, and beta-cell sensitivity to glucose from baseline in the RYGB, but not the GR, patients indicating an “enhanced incretin response” says the team.
“Our data provide new insights into the acute metabolic effects of the intestinal bypass component of gastrointestinal bariatric surgery on hyperglycemia and beta-cell function,” conclude Kashyap et al in the International Journal of Obesity.
They add: “The rapid improvement in beta-cell function after RYGB has significant clinical implications for the further development and application of surgical approaches for the treatment of obesity and Type 2 diabetes mellitus.”
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