Marked Improvement of Insulin Sensitivity Without Enhancement of GLP-1 and Insulin Secretion After Roux-en-Y Gastric Bypass Surgery in a Mildly Obese Patient with Diabetes

K. Yamashita; Y. Sato; K. Oki; H. Kishimoto; K. Yamauchi; T. Aizawa

doi:10.1055/s-0034-1367026

Hormone and Metabolic Research, Inhaltsverzeichnis

Horm Metab Res 2014; 46(06): 424-426
DOI: 10.1055/s-0034-1367026

Endocrine Care

Marked Improvement of Insulin Sensitivity Without Enhancement of GLP-1 and Insulin Secretion After Roux-en-Y Gastric Bypass Surgery in a Mildly Obese Patient with Diabetes

K. Yamashita

¹Diabetes Center, Aizawa Hospital, Matsumoto, Japan

³Current Address: Diabetes Center, Okaya Hospital, Okaya, Japan

,

Y. Sato

¹Diabetes Center, Aizawa Hospital, Matsumoto, Japan

,

K. Oki

²Department of Surgery, Aizawa Hospital, Matsumoto, Japan

,

H. Kishimoto

²Department of Surgery, Aizawa Hospital, Matsumoto, Japan

,

K. Yamauchi

¹Diabetes Center, Aizawa Hospital, Matsumoto, Japan

,

T. Aizawa

¹Diabetes Center, Aizawa Hospital, Matsumoto, Japan

› Institutsangaben

Abstract

Roux-en-Y gastric bypass is an option of treatment for morbidly obese patients with diabetes. However, the value of the operation in mildly obese patients is not established. We report the first prospective systematic endocrine and metabolic analysis in a mildly obese patient who underwent a Roux-en-Y gastric bypass. In a 49-year-old man with BMI 32.6 kg/m² having type 2 diabetes, intramucosal gastric cancer was treated by partial gastrectomy with Roux-en-Y gastric bypass. Pre-operatively, he received 53 U/day insulin and the HbA1c value was 63 mmol/mol: meal tolerance test showed diabetic hyperglycemia and low insulin sensitivity with attenuated insulin secretion and normal glucagon-like peptide 1(7–36) secretion. After the operation, hypoglycemic agent was stopped. Body weight reduced from 84.0 to 77.0 kg within 2 weeks and increased thereafter to 79.4 kg at 4 months later, when the degree of hyperglycemia was unchanged as indexed by a HbA1c value of 62 mmol/mol. Upon repeated meal tolerance test, no increase of glucagon-like peptide 1 and insulin secretion, but significantly improved hepatic and peripheral insulin sensitivity were found, compared to the preoperative meal tolerance test. Marked dissociation of endocrine and metabolic effects of Roux-en-Y gastric bypass, that is, absence of increased glucagon-like peptide 1/insulin secretion with improvement of insulin sensitivity, was found in a mildly obese patient with type 2 diabetes.

Key words

GLP-1 - insulin - RYGB

Volltext

Referenzen

References
1 Dirksen C, Jørgensen NB, Bojsen-Møller KN, Jacobsen SH, Hansen DL, Worm D, Holst JJ, Madsbad S. Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass. Diabetologia 2012; 55: 1890-1901
2 Anderwald CH, Tura A, Promintzer-Schifferl M, Prager G, Stadler M, Ludvik B, Esterbauer H, Bischof MG, Luger A, Pacini G, Krebs M. Alterations in gastrointestinal, endocrine, and metabolic processes after bariatric Roux-en-Y gastric bypass surgery. Diabetes Care 2012; 35: 2580-2587
3 Vincent RP, le Roux CW. Changes in gut hormones after bariatric surgery. Clin Endocrinol 2008; 69: 173-179
4 Vidal J, Nicolau J, Romero F, Casamitjana R, Momblan D, Conget I, Morínigo R, Lacy AM. Long-term effects of Roux-en-Y gastric bypass surgery on plasma glucagon-like peptide-1 and islet function in morbidly obese subjects. J Clin Endocrinol Metab 2009; 94: 884-891
5 Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care 2012; 35: 1420-1428
6 Dixon JB, Hur KY, Lee WJ, Kim MJ, Chong K, Chen SC, Straznicky NE, Zimmet P. Gastric bypass in Type 2 diabetes with BMI<30: weight and weight loss have a major influence on outcomes. Diabet Med 2013; 30: e127-e134
7 Tripathy D, Almgren P, Tuomi T, Groop L. Contribution of insulin-stimulated glucose uptake and basal hepatic insulin sensitivity to surrogate measures of insulin sensitivity. Diabetes Care 2004; 27: 2204-2210
8 Iwata M, Maeda S, Kamura Y, Takano A, Kato H, Murakami S, Higuchi K, Takahashi A, Fujita H, Hara K, Kadowaki T, Tobe K. Genetic risk score constructed using 14 susceptibility alleles for type 2 diabetes is associated with the early onset of diabetes and may predict the future requirement of insulin injections among Japanese individuals. Diabetes Care 2012; 35: 1763-1770
9 Calanna S, Christensen M, Holst JJ, Laferrère B, Gluud LL, Vilsbøll T, Knop FK. Secretion of glucagon-like peptide-1 in patients with type 2 diabetes mellitus: systematic review and meta-analyses of clinical studies. Diabetologia 2013; 56: 965-972
10 Kahn SE, Prigeon RL, McCulloch DK, Boyko EJ, Bergman RN, Schwartz MW, Neifing JL, Ward WK, Beard JC, Palmer JP, Porte Jr D. Quantification of the relationship between insulin sensitivity and beta cell function in human subjects. Evidence for a hyperbolic function. Diabetes 1993; 42: 1663-1672
11 Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care 2004; 27: 1487-1495