The Effect of Laparoscopic Gastric Bypass Surgery on Insulin Resistance and Glycosylated Hemoglobin A1c: a 2-Year Follow-up Study

Abstract Background Bariatric surgery improves insulin sensitivity and secretion in patients with type 2 diabetes, but the effect on patients with prediabetes or even normal glucose tolerance deserves further consideration. Methods Cohort study including patients operated with laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) between November 2012 and June 2017 at the Örebro University Hospital (n = 813) with follow-up of 742 patients 2 years after surgery. Fasting insulin, glucose, glycosylated hemoglobin (HbA1c), and homeostatic model assessment of insulin resistance (HOMA-IR) were analyzed at baseline and 2 years after surgery for patients with overt type 2 diabetes, prediabetes, or non-diabetes. Results Fasting insulin levels improved for all groups (diabetics baseline 25.5 mIU/L, IQR 17.5–38.0, 2 years 7.6 mIU/L, IQR 5.4–11.1, p < 0.001; prediabetics baseline 25.0 mIU/L, IQR 17.5–35.0, 2 years 6.7mIU/L, IQR 5.3–8.8, p < 0.001; non-diabetics baseline 20.0 mIU/L, IQR 14.0–30.0, 2 years 6.4 mIU/L, IQR 5.0–8.5, p < 0.001). HbA1c improved in all groups (diabetics baseline 56 mmol/mol, IQR 49–74 [7.3%, IQP 6.6–8.9], 2 years 38 mmol/mol, IQR 36–47 [5.6%, IQR 5.4–6.4], p < 0.001; prediabetics baseline 40 mmol/mol, IQR 39–42 [5.8%, IQR5.7–6.0], 2 years 36 mmol/mol, IQR 34–38 [5.5%, IQR 5.3–5.6], p < 0.001; non-diabetics baseline 35 mmol/mol, IQR 33–37 [5.4%, IQR 5.2–5.5]; 2 years 34 mmol/mol, IQR 31–36 [5.3%, IQR 5.0–5.4], p < 0.001). HOMA-IR improved in all groups (diabetics baseline 9.3 mmol/mol, IQR 5.4–12.9, 2 years 1.9 mmol/mol, IQR 1.4–2.7, p < 0.001; prediabetics baseline 7.0 mmol/mol, IQR 4.3–9.9, 2 years 1.6 mmol/mol, IQR 1.2–2.1, p < 0.001; non-diabetics 4.9 mmol/mol, IQR 3.4–7.3, 2 years 1.4 mmol/mol, IQR 1.1–1.9, p < 0.001). Conclusion Insulin homeostasis and glucometabolic control improve in all patients after LRYGB, not only in diabetics but also in prediabetics and non-diabetic obese patients, and this improvement is sustained 2 years after surgery.

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Quality of life after gastric bypass surgery in patients with type 2 diabetes: patients’ experiences during 2 years of follow-up

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-020-00597-1 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Petros Katsogiannos ◽

Eva Randell ◽

Magnus Sundbom ◽

Andreas Rosenblad ◽

Jan W. Eriksson ◽

...

Keyword(s):

Quality Of Life ◽

Type 2 Diabetes ◽

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Well Being ◽

Obese Patients

Abstract Background To examine the effects of gastric bypass surgery on health-related quality of life (HRQoL) in obese patients with type 2 diabetes, and to investigate their experiences of life adjustments using quantitative and qualitative methods. Methods Thirteen patients with type 2 diabetes and obesity, (body mass index, BMI > 30 kg/m2), participating in a randomized clinical trial, completed this sub-study. HRQoL was evaluated before, and at 6 months and 2 years after gastric bypass surgery, using the RAND- 36-item health survey. At 2 years, interviews for in-depth analysis of HRQoL changes were performed. Results Significant improvement was observed from baseline to 6 months for 2 of the eight health concepts, general health, and emotional well-being. At 2 years, improvements were also seen in physical functioning, energy/fatigue, as well as sustained improvements in general health and emotional well-being. Multiple regression analyses showed mostly non-significant associations between the magnitude of decrease in weight, BMI, and HbA1c during follow-up and improvement in HRQoL. The analyses from qualitative interviews supported a common latent theme “Finding a balance between the experience of the new body weight and self-confidence”. Conclusions The improved HRQoL after gastric bypass surgery in obese patients with type 2 diabetes was not explained specifically by the magnitude of weight loss, but rather by the participants achieving a state of union between body and consciousness. Trial registration ClinicalTrials.gov Identifier NCT02729246. Date of registration 6 April 2016 – Retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02729246?term=bariglykos&draw=2&rank=1

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Reduction in endotoxemia, oxidative and inflammatory stress, and insulin resistance after Roux-en-Y gastric bypass surgery in patients with morbid obesity and type 2 diabetes mellitus

Surgery ◽

10.1016/j.surg.2011.09.038 ◽

2012 ◽

Vol 151 (4) ◽

pp. 587-593 ◽

Cited By ~ 77

Author(s):

Scott V. Monte ◽

Joseph A. Caruana ◽

Husam Ghanim ◽

Chang Ling Sia ◽

Kelly Korzeniewski ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Type 2 Diabetes ◽

Morbid Obesity ◽

Gastric Bypass ◽

Type 2 Diabetes Mellitus ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Inflammatory Stress

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Association of endothelial dysfunction with incident prediabetes, type 2 diabetes and related traits: the KORA F4/FF4 study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001321 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001321

Author(s):

Marie-Theres Huemer ◽

Cornelia Huth ◽

Florian Schederecker ◽

Stefanie J Klug ◽

Christa Meisinger ◽

...

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Endothelial Dysfunction ◽

Endothelial Function ◽

Fasting Glucose ◽

Model Assessment ◽

Fasting Insulin ◽

Homeostasis Model Assessment

IntroductionPeripheral arterial tonometry (PAT) is an operator-independent and non-invasive measurement method to assess microvascular endothelial function in the fingertips. PAT-derived measures of endothelial function were associated with type 2 diabetes in cross-sectional studies. However, longitudinal studies are lacking. The study aims to investigate the association of two PAT-derived endothelial function parameters reactive hyperemia index (RHI) and mean baseline amplitude (MBA) with follow-up glucose and insulin parameters and the development of (pre)diabetes and type 2 diabetes.Research design and methodsThe study included 673 participants initially without diabetes (328 men and 345 women) aged 52–71 years from the prospective population-based Cooperative Health Research in the Region of Augsburg F4/FF4 cohort study conducted in Southern Germany (baseline examination F4: 2006–2008; follow-up FF4: 2013–2014). An oral glucose tolerance test was performed at baseline and follow-up to define type 2 diabetes, prediabetes, fasting glucose, fasting insulin, 2-hour glucose, homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of beta-cell function and hemoglobin A1c.ResultsIn multivariable adjusted logistic/linear regression models, a 1 SD increase in baseline RHI was inversely associated with incident type 2 diabetes (OR 0.69 (95% CI 0.48 to 0.97)) as well as with fasting insulin (β −0.069 (95% CI −0.131 to −0.007)) and HOMA-IR (β −0.072 (95% CI −0.133 to −0.010)) at follow-up in participants with initial normoglycemia. A 1 SD increase in baseline MBA was positively associated with incident (pre)diabetes (OR 1.62 (95% CI 1.25 to 2.11)) and fasting glucose (β 0.096 (95% CI 0.047 to 0.146)) at follow-up in participants with initial normoglycemia.ConclusionsMicrovascular endothelial dysfunction seems to be involved in the development of early derangements in glucose metabolism and insulin resistance and could thereby trigger the development of prediabetes and type 2 diabetes.

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The Pros and Cons of Gastric Bypass Surgery in Obese Individuals with Type 2 Diabetes—Nationwide, Matched, Observational Cohort Study

Diabetes ◽

10.2337/db18-131-or ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 131-OR

Author(s):

VASILEIOS LIAKOPOULOS ◽

ANN-MARIE SVENSSON ◽

INGMAR NASLUND ◽

BJORN ELIASSON

Keyword(s):

Type 2 Diabetes ◽

Gastric Bypass ◽

Cohort Study ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Observational Cohort Study ◽

Observational Cohort ◽

Pros And Cons

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Circulating magnesium status is associated with type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a long-term cohort study

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2020.09.036 ◽

2020 ◽

Author(s):

Arvo Haenni ◽

Inger Nilsen

Keyword(s):

Type 2 Diabetes ◽

Gastric Bypass ◽

Cohort Study ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Diabetes Remission ◽

Magnesium Status ◽

Type 2 Diabetes Remission

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Mechanisms behind the immediate effects of Roux-en-Y gastric bypass surgery on type 2 diabetes

Theoretical Biology and Medical Modelling ◽

10.1186/1742-4682-10-45 ◽

2013 ◽

Vol 10 (1) ◽

Cited By ~ 23

Author(s):

Roland E Allen ◽

Tyler D Hughes ◽

Jia Lerd Ng ◽

Roberto D Ortiz ◽

Michel Abou Ghantous ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery

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Long-Term Effects of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Surgery on Type 2 Diabetes Mellitus in Morbidly Obese Subjects

Annals of Surgery ◽

10.1097/sla.0b013e318262ee6b ◽

2012 ◽

Vol 256 (6) ◽

pp. 1023-1029 ◽

Cited By ~ 167

Author(s):

Amanda Jiménez ◽

Roser Casamitjana ◽

Lílliam Flores ◽

Judith Viaplana ◽

Ricard Corcelles ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Morbidly Obese ◽

Long Term Effects ◽

Obese Subjects

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“Dual-remission” after Roux-en-Y gastric bypass surgery: Glycemic variability cannot always be improved in Chinese obese patients with type 2 diabetes

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2015.10.076 ◽

2016 ◽

Vol 12 (7) ◽

pp. 1312-1319 ◽

Cited By ~ 4

Author(s):

Haoyong Yu ◽

Jian Zhou ◽

Yuqian Bao ◽

Pin Zhang ◽

Wei Lu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Glycemic Variability ◽

Obese Patients

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Pancreatic hyperplasia after gastric bypass surgery in a GK rat model of non-obese type 2 diabetes

Journal of Endocrinology ◽

10.1530/joe-14-0701 ◽

2015 ◽

Vol 228 (1) ◽

pp. 13-23 ◽

Cited By ~ 11

Author(s):

Xinrong Zhou ◽

Bangguo Qian ◽

Ning Ji ◽

Conghui Lui ◽

Zhiyuan Liu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gastric Bypass ◽

Rat Model ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Cell Mass ◽

Cell Area ◽

Obese Patients ◽

Β Cell

Gastric bypass surgery produces clear antidiabetic effects in a substantial proportion of morbidly obese patients. In view of the recent trend away from ‘bariatric’ surgery and toward ‘metabolic’ surgery, it is important to elucidate the enhancing effect of bypass surgery on pancreatic β-cell mass, which is related to diabetes remission in non-obese patients. We investigated the effects of gastric bypass surgery on glycemic control and other pancreatic changes in a spontaneous non-obese type 2 diabetes Goto-Kakizaki rat model. Significant improvements in postprandial hyperglycemia and plasma c-peptide level were observed when glucose was administered orally post-surgery. Other important events observed after surgery were enhanced first phase insulin secretion in a in site pancreatic perfusion experiment, pancreatic hyperplasia, improved islet structure (revealed by immunohistochemical analysis), striking increase in β-cell mass, slight increase in ratio of β-cell area to total pancreas area, and increased number of small islets closely related to exocrine ducts. No notable changes were observed in ratio of β-cell to non-β endocrine cell area, β-cell apoptosis, or β-cell proliferation. These findings demonstrate that gastric bypass surgery in this rat model increases endocrine cells and pancreatic hyperplasia, and reflect the important role of the gastrointestinal system in regulation of metabolism.

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