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Horm Metab Res 2016; 48(05): 312-317
DOI: 10.1055/s-0041-111505
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Comparative Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Glucose Homeostasis and Incretin Hormones in Obese Type 2 Diabetic Patients: A One-Year Prospective Study

G. Nosso
1   Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
,
E. Griffo
1   Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
,
M. Cotugno
1   Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
,
G. Saldalamacchia
1   Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
,
R. Lupoli
1   Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
,
G. Pacini
2   Metabolic Unit, CNR Neuroscience Institute, Padova, Italy
,
G. Riccardi
1   Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
,
L. Angrisani
3   General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
,
B. Capaldo
1   Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
› Author Affiliations
Further Information

Publication History

received 24 June 2015

accepted after second revision 09 December 2015

Publication Date:
20 January 2016 (online)

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Abstract

The aim of the work was to compare the hormonal and the metabolic mechanisms involved in weight loss and remission of T2DM one year after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) in morbidly obese type 2 diabetic (T2DM) patients. Insulin sensitivity, insulin secretion, and the gastrointestinal (GI) hormone response to a mixed meal test (MMT) were evaluated before and one year after BS (14 RYGB and 19 VSG). RYGB and VSG groups had similar characteristics at baseline. Weight loss at one year was similar in the 2 groups (ΔBMI%: − 32±10 and − 30±7%, p=0.546). Insulin sensitivity and insulin secretion improved similarly after either procedures with a similar rate in T2DM remission (86% in RYGB and 76% in VSG). Meal-stimulated GLP-1 levels increased after both procedures reaching significantly higher levels after RYGB (p=0.0001). GIP response to MMT decreased to a similar extent after the 2 interventions (p=0.977). Both fasting and post-meal ghrelin concentrations were markedly suppressed after VSG and significantly lower than RYGB (p=0.013 to p=0.035). The improvement of insulin sensitivity and beta-cell function was significantly associated with weight loss (p=0.014 to p=0.035), while no relation was found with the changes in GI hormones. In conclusion, in morbidly obese T2DM patients, RYGB and VSG result in similar improvements of the glucose status in the face of different GI hormonal pattern. Weight loss is the key determinant of diabetes remission one year after surgery.

Key words

bariatric surgery - diabetes - GI hormones - insulin sensitivity - insulin secretion
 

  • References

  • 1 Dixon JB, le Roux CW, Rubino F, Zimmet P. Bariatric surgery for type 2 diabetes. Lancet 2012; 16: 2300-2311
    PubMedGoogle Scholar
  • 2 Puzziferri N, Roshek 3rd TB, Mayo HG, Gallagher R, Belle SH, Livingston EH. Long-term follow-up after bariatric surgery: a systematic review. JAMA 2014; 312: 934-942
    CrossrefPubMedGoogle Scholar
  • 3 Guidone C, Manco M, Valera-Mora E, Iaconelli A, Gniuli D, Mari A, Nanni G, Castagneto M, Calvani M, Mingrone G. Mechanisms of recovery from type 2 diabetes after malabsorptive bariatric surgery. Diabetes 2006; 55: 2025-2031
    CrossrefPubMedGoogle Scholar
  • 4 Rubino F, Forgione A, Cummings DE, Vix M, Gnuli D, Mingrone G, Castagneto M, Marescaux J. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 2006; 244: 741-749
    CrossrefPubMedGoogle Scholar
  • 5 Kamvissi V, Salerno A, Bornstein SR, Mingrone G, Rubino F. Incretins or Anti-Incretins? A new model for the “Entero-Pancreatic Axis”. Horm Metab Res 2015; 47: 84-87
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Vollmer K, Holst JJ, Baller B, Ellrichmann M, Nauck MA, Schmidt WE, Meier JJ. Predictors of incretin concentrations in subjects with normal, impaired, and diabetic glucose tolerance. Diabetes 2008; 57: 678-687
    CrossrefPubMedGoogle Scholar
  • 7 Nosso G, Angrisani L, Saldalamacchia G, Cutolo PP, Cotugno M, Lupoli R, Vitolo G, Capaldo B. Impact of sleeve gastrectomy on weight loss, glucose homeostasis, and comorbidities in severely obese type 2 diabetic subjects. J Obes 2011; 340867
    PubMedGoogle Scholar
  • 8 Di Marino L, Griffo E, Maione S, Mirabella M. Active glucagon-like peptide-1 (GLP-1): storage of human plasma and stability over time. Clin Chim Acta 2011; 412: 1693-1694
    CrossrefPubMedGoogle Scholar
  • 9 Tvarijonaviciute A, Martínez-Subiela S, Ceron JJ. Influence of different storage conditions and anticoagulants on the measurement of total and acylated ghrelin in dogs: a preliminary study. Vet Rec 2013; 172: 289
    CrossrefPubMedGoogle Scholar
  • 10 Griffo E, Nosso G, Lupoli R, Cotugno M, Saldalamacchia G, Vitolo G, Angrisani L, Cutolo PP, Rivellese AA, Capaldo B. Early improvement of postprandial lipemia after bariatric surgery in obese Type 2 diabetic patients. Obes Surg 2014; 24: 765-770
    CrossrefPubMedGoogle Scholar
  • 11 Manley S. Haemoglobin A1c – a marker for complications of type 2 diabetes: the experience from the UK Prospective Diabetes Study (UKPDS). Clin Chem Lab Med 2003; 41: 1182-1190
    PubMedGoogle Scholar
  • 12 Deitel M, Gawdat K, Melissas J. Reporting Weight Loss 2007. Obes Surg 2007; 17: 565-568
    PubMedGoogle Scholar
  • 13 Mari A, Pacini G, Murphy E, Ludvik B, Nolan JJ. A model-based method for assessing insulin sensitivity from the oral glucose tolerance test. Diabetes Care 2001; 24: 539-548
    CrossrefPubMedGoogle Scholar
  • 14 Van Cauter E, Mestrez F, Sturis J, Polonsky KS. Estimation of insulin secretion rates from C-peptide levels: comparison of individual and standard kinetic parameters for C-peptide clearance. Diabetes 1992; 41: 368-377
    CrossrefPubMedGoogle Scholar
  • 15 Ahrén B, Pacini G. Impaired adaptation of first-phase insulin secretion in postmenopausal women with glucose intolerance. Am J Physiol 1997; 273 (4 Pt 1) E701-E707
    PubMedGoogle Scholar
  • 16 Keidar A, Hershkop KJ, Marko L, Schweiger C, Hecht L, Bartov N, Kedar A, Weiss R. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial. Diabetologia 2013; 56: 1914-1918
    CrossrefPubMedGoogle Scholar
  • 17 Nannipieri M, Baldi S, Mari A, Colligiani D, Guarino D, Camastra S, Barsotti E, Berta R, Moriconi D, Bellini R, Anselmino M, Ferrannini E. Roux-en-Y gastric bypass and sleeve gastrectomy: mechanisms of diabetes remission and role of gut hormones. J Clin Endocrinol Metab. 2013; 98: 4391-4399
    CrossrefPubMedGoogle Scholar
  • 18 Kashyap SR, Bhatt DL, Wolski K, Watanabe RM, Abdul-Ghani M, Abood B, Pothier CE, Brethauer S, Nissen S, Gupta M, Kirwan JP, Schauer PR. Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes Care 2013; 36: 2175-2182
    CrossrefPubMedGoogle Scholar
  • 19 Lee WJ, Chong K, Lin YH, Wei JH, Chen SC. Laparoscopic sleeve gastrectomy versus single anastomosis (Mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect. Obes Surg 2014; 24: 1552-1562
    CrossrefPubMedGoogle Scholar
  • 20 Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD et al. Bariatric surgery versus intensive medical therapy for diabetes – 3-year outcomes. N Engl J Med 2014; 370: 2002-2013
    CrossrefPubMedGoogle Scholar
  • 21 Laferrère B, Teixeira J, McGinty J, Tran H, Egger JR, Colarusso A, Kovack B, Bawa B, Koshy N, Lee H, Yapp K, Olivan B. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab 2008; 93: 2479-2485
    CrossrefPubMedGoogle Scholar
  • 22 Korner J, Bessler M, Inabnet W, Taveras C, Holst JJ. Exaggerated glucagon-like peptide-1 and blunted glucose-dependent insulinotropic peptide secretion are associated with Roux-en-Y gastric bypass but not adjustable gastric banding. Surg Obes Relat Dis 2007; 3: 597-601
    CrossrefPubMedGoogle Scholar
  • 23 Jimenez A, Casamitjana R, Viaplana-Masclans J, Lacy A, Vidal J. GLP-1 action and glucose tolerance in subjects with remission of type 2 diabetes mellitus after gastric bypass surgery. Diabetes Care 2013; 36: 2062-2069
    CrossrefPubMedGoogle Scholar
  • 24 Madsbad S, Holst JJ. GLP-1 as a mediator in the remission of type 2 diabetes after gastric bypass and sleeve gastrectomy surgery. Diabetes 2014; 63: 3172-3174
    CrossrefPubMedGoogle Scholar
  • 25 Lind L, Zethelius B, Sundbom M, Eden Engstrom B, Karlsson FA. Vasoreactivity is rapidly improved in obese subjects after gastric bypass surgery. Int J Obes 2009; 33: 1390-1395
    CrossrefPubMedGoogle Scholar
  • 26 Sweeney TE, Morton JM. The human gut microbiome: a review of the effect of obesity and surgically induced weight loss. JAMA Surg 2013; 148: 563-569
    CrossrefPubMedGoogle Scholar
  • 27 Mingrone G, Rosa G, Greco AV, Manco M, Vega N, Nanni G, Castagneto M, Vidal H. Intramyocitic lipid accumulation and SREBP-1c expression are related to insulin resistance and cardiovascular risk in morbid obesity. Atherosclerosis 2003; 170: 155-161
    CrossrefPubMedGoogle Scholar
  • 28 Benaiges D, Flores-Le-Roux JA, Pedro-Botet J, Ramon JM, Parri A, Villatoro M, Carrera MJ, Pera M, Sagarra E, Grande L, Goday A. Obemar Group . Impact of restrictive (sleeve gastrectomy) vs hybrid bariatric surgery (Roux-en- Y gastric bypass) on lipid profile. Obes Surg 2012; 22: 1268-1275
    CrossrefPubMedGoogle Scholar
  • 29 Griffo E, Cotugno M, Nosso G, Saldalamacchia G, Mangione A, Angrisani L, Rivellese AA, Capaldo B. Effects of sleeve gastrectomy and gastric bypass on postprandial lipid profile in obese type 2 diabetic patients: a 2-year follow-up. Obes Surg 2015; Oct 5 [Epub ahead of print]
    PubMedGoogle Scholar
  • 30 Benetti A, Del Puppo M, Crosignani A, Veronelli A, Masci E, Frigè F, Micheletto G, Panizzo V, Pontiroli AE. Cholesterol metabolism after bariatric surgery in grade 3 obesity: differences between malabsorptive and restrictive procedures. Diabetes Care 2013; 36: 1443-1447
    CrossrefPubMedGoogle Scholar