The Recovery of Beta-Cell Function is Critical for Antidiabetic Outcomes of Gastric Bypass in Asian Subjects with Type 2 Diabetes and a Body Mass Index Below 30

Abstract Objective This study aimed to clarify the clinical significance of the maximum body mass index (BMI) before the onset of type 2 diabetes (MBBO) for predicting pancreatic beta-cell function. Methods This was a cross-sectional observational study. Of 1304 consecutively admitted patients with type 2 diabetes, we enrolled 410 patients satisfying the criteria in this study. The correlations between the C-peptide index (CPI), which is one of the parameters that reflects beta-cell function, and various clinical parameters, including MBBO and duration of diabetes, were analyzed in multiple linear regression analyses. Results The analyses revealed that MBBO was correlated with CPI independently after adjustment for age, sex, HbA1c, and duration of diabetes. When we divided the subjects into three subgroups by MBBO (MBBO < 25 kg/m2; 25 kg/m2 ≤ MBBO < 30 kg/m2; MBBO ≥ 30 kg/m2), CPI was negatively correlated with duration of diabetes in each subgroup, while the rates of CPI based on the duration of diabetes were not different among the three MBBO subgroups. In contrast, the declining rates of CPI were higher in the BMI ≥ 25 kg/m2 group on admission than in the BMI < 25 kg/m2 group on admission. Conclusions MBBO may be an independent factor correlating with beta-cell function and may predict insulin secretion capacity at diagnosis, but it does not seem to affect the rate of decline in insulin secretion capacity after diagnosis. It is important to preserve beta-cell function by decreasing a patient’s BMI during treatment after diagnosis regardless of MBBO.

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Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Achieve Similar Early Improvements in Beta-cell Function in Obese Patients with Type 2 Diabetes

Scientific Reports ◽

10.1038/s41598-018-38283-y ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 5

Author(s):

Jamie A. Mullally ◽

Gerardo J. Febres ◽

Marc Bessler ◽

Judith Korner

Keyword(s):

Type 2 Diabetes ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Beta Cell ◽

Beta Cell Function ◽

Cell Function ◽

Obese Patients

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Sustained Improvements in Glucose Metabolism Late After Roux-En-Y Gastric Bypass Surgery in Patients with and Without Preoperative Diabetes

Scientific Reports ◽

10.1038/s41598-019-51516-y ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Nils B. Jørgensen ◽

Kirstine N. Bojsen-Møller ◽

Carsten Dirksen ◽

Christoffer Martinussen ◽

Maria S. Svane ◽

...

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Gastric Bypass ◽

Glucose Metabolism ◽

Beta Cell ◽

Beta Cell Function ◽

Cell Function ◽

Relative Change

Abstract To describe glucose metabolism in the late, weight stable phase after Roux-en-Y Gastric Bypass (RYGB) in patients with and without preoperative type 2 diabetes we invited 55 RYGB-operated persons from two existing cohorts to participate in a late follow-up study. 44 (24 with normal glucose tolerance (NGT)/20 with type 2 diabetes (T2D) before surgery) accepted the invitation (median follow-up 2.7 [Range 2.2–5.0 years]). Subjects were examined during an oral glucose stimulus and results compared to preoperative and 1-year (1 y) post RYGB results. Glucose tolerance, insulin resistance, beta-cell function and incretin hormone secretion were evaluated. 1 y weight loss was maintained late after surgery. Glycemic control, insulin resistance, beta-cell function and GLP-1 remained improved late after surgery in both groups. In NGT subjects, nadir glucose decreased 1 y after RYGB, but did not change further. In T2D patients, relative change in weight from 1 y to late after RYGB correlated with relative change in fasting glucose and HbA1c, whereas relative changes in glucose-stimulated insulin release correlated inversely with relative changes in postprandial glucose excursions. In NGT subjects, relative changes in postprandial nadir glucose correlated with changes in beta-cell glucose sensitivity. Thus, effects of RYGB on weight and glucose metabolism are maintained late after surgery in patients with and without preoperative T2D. Weight loss and improved beta-cell function both contribute to maintenance of long-term glycemic control in patients with type 2 diabetes, and increased glucose stimulated insulin secretion may contribute to postprandial hypoglycemia in NGT subjects.

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Blood intact incretin levels are related to beta-cell function and glycemia in patients with type 2 diabetes

Endocrine Abstracts ◽

10.1530/endoabs.63.gp201 ◽

2019 ◽

Author(s):

Yeekyoung Ko ◽

Soyeon Yoo ◽

Gwanpyo Koh

Keyword(s):

Type 2 Diabetes ◽

Beta Cell ◽

Beta Cell Function ◽

Cell Function

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Pancreatic Fat Is Associated With Metabolic Syndrome and Visceral Fat but Not Beta-Cell Function or Body Mass Index in Pediatric Obesity

Pancreas ◽

10.1097/mpa.0000000000000771 ◽

2017 ◽

Vol 46 (3) ◽

pp. 358-365 ◽

Cited By ~ 23

Author(s):

Johan Staaf ◽

Viktor Labmayr ◽

Katharina Paulmichl ◽

Hannes Manell ◽

Jing Cen ◽

...

Keyword(s):

Metabolic Syndrome ◽

Body Mass Index ◽

Beta Cell ◽

Body Mass ◽

Visceral Fat ◽

Pediatric Obesity ◽

Beta Cell Function ◽

Cell Function ◽

Pancreatic Fat

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Revisional large gastric pouch with Roux-en-Y gastric bypass for patients with type 2 diabetes and a body mass index less than 35 kg/m2: a cause and effect analysis

Surgery Today ◽

10.1007/s00595-021-02317-2 ◽

2021 ◽

Author(s):

Xiang Gao ◽

Liyong Zhu ◽

Weizheng Li ◽

Shaihong Zhu ◽

Pengzhou Li

Keyword(s):

Type 2 Diabetes ◽

Body Mass Index ◽

Gastric Bypass ◽

Body Mass ◽

Gastric Pouch ◽

Effect Analysis ◽

Cause And Effect ◽

Cause And Effect Analysis

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Effects of efpeglenatide versus liraglutide on gastric emptying, glucose metabolism and beta-cell function in people with type 2 diabetes: an exploratory, randomized phase Ib study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2021-002208 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002208

Author(s):

Marcus Hompesch ◽

Jahoon Kang ◽

OakPil Han ◽

Michael E Trautmann ◽

Christopher H Sorli ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gastric Emptying ◽

Glucose Metabolism ◽

Beta Cell ◽

Beta Cell Function ◽

Cell Function ◽

Phase Ib ◽

Link Type ◽

Drug Concentrations

IntroductionTo evaluate the effects of efpeglenatide, a long-acting glucagon-like peptide-1 receptor agonist (GLP-1 RA), on gastric emptying, glucose metabolism, and islet beta-cell function versus liraglutide and placebo in people with type 2 diabetes.Research design and methodsThis phase Ib study (ClinicalTrials.gov identifier: NCT02059564) randomized participants (n=47) to three cohorts. Within the first two cohorts, participants were randomized to placebo, efpeglenatide 6 mg weekly (QW; first cohort), or efpeglenatide 16 mg monthly (QM; second cohort). The third cohort received liraglutide 1.8 mg daily (QD). Gastric emptying was assessed through the pharmacokinetic (PK) profile of acetaminophen at baseline and steady state. Glucose metabolism and beta-cell function were assessed based on mixed-meal tolerance testing and a graded glucose infusion procedure.ResultsTreatment duration was approximately 3 months for efpeglenatide 16 mg QM and 1 month for efpeglenatide 6 mg QW and liraglutide. At peak drug concentrations, efpeglenatide 6 mg QW was non-inferior to liraglutide 1.8 mg QD in delaying gastric emptying, as assessed by acetaminophen PK (lower bound of 90% CI for the efpeglenatide:liraglutide ratio >0.8 for area under the curve (AUC)0–120, AUC0–180, AUC0–360 and maximum concentration (Cmax)). Efpeglenatide 16 mg QM did not decrease the rate of gastric emptying to as great an extent as liraglutide (ie, non-inferiority was not shown). Compared with liraglutide, both efpeglenatide dosing regimens demonstrated comparable or more favorable glucometabolic effects and improved beta-cell function. All gastrointestinal adverse events reported with efpeglenatide were mild or moderate in severity and transient over treatment and follow-up.ConclusionsThe glucometabolic effects of efpeglenatide 6 mg QW and 16 mg QM were comparable to liraglutide. Additional studies are necessary to further examine these benefits of efpeglenatide.Trial registration numberNCT02059564.

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