Increased Insulin Secretion and Glucose Effectiveness in Obese Patients with Type 2 Diabetes Following Bariatric Surgery

Overview

Journal J Diabetes Res

Publisher Wiley

Specialty Endocrinology

Date 2023 Nov 29

PMID 38020201

Authors

Roberto Visentin

Katrine Brodersen

Bjorn Richelsen

Niels Moller

Chiara Dalla Man

Andreas Kristian Pedersen

Jan Abrahamsen

Jens Juul Holst

Michael Festersen Nielsen

Affiliations

Soon will be listed here.

Abstract

Background: -cell dysfunction and insulin resistance are the main mechanisms causing glucose intolerance in type 2 diabetes (T2D). Bariatric surgeries, i.e., sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), are procedures both known to induce weight loss, increase insulin action, and enhance -cell function, but hepatic insulin extraction and glucose effectiveness may also play a role.

Methods: To determine the contribution of these regulators on glucose tolerance after bariatric surgery, an oral glucose tolerance test (OGTT) was performed before and 2 months after surgery in 9 RYGB and 7 SG subjects. Eight healthy subjects served as metabolic controls. Plasma glucose, insulin, C-peptide, GLP-1, and GIP were measured during each OGTT. Insulin sensitivity and secretion, glucose effectiveness, and glucose rate of appearance were determined via oral minimal models.

Results: RYGB and SG resulted in similar weight reductions (13%, RYGB ( < 0.01); 14%, SG ( < 0.05)). Two months after surgery, insulin secretion ( < 0.05) and glucose effectiveness both improved equally in the two groups (11%, RYGB ( < 0.01); 8%, SG ( > 0.05)), whereas insulin sensitivity remained virtually unaltered. Bariatric surgery resulted in a comparable increase in the GLP-1 response during the OGTT, whereas GIP concentrations remained unaltered. Following surgery, oral glucose intake resulted in a comparable increase in hepatic insulin extraction, the response in both RYGB and SG patients significantly exceeding the response observed in the control subjects.

Conclusions: These results demonstrate that the early improvement in glucose tolerance in obese T2D after RYGB and SG surgeries is attributable mainly to increased insulin secretion and glucose effectiveness, while insulin sensitivity seems to play only a minor role. This trial is registered with NCT02713555.

Citing Articles

Investigating a New Way to Assess Metabolic Risk in Pregnant Females with Prior RYGB Surgery.

Gisinger T, Reiter B, Preindl K, Stimpfl T, Gard L, Baumgartner-Parzer S Nutrients. 2024; 16(16).

PMID: 39203840 PMC: 11357170. DOI: 10.3390/nu16162704.

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