The Role of β-Cell Function and Insulin Sensitivity in the Remission of Type 2 Diabetes after Gastric Bypass Surgery

Bariatric surgery is currently the most effective and durable therapy for obesity. Roux-en-Y gastric bypass surgery, the most commonly performed procedure worldwide, causes substantial weight loss and improvement in several comorbidities associated with obesity, especially type 2 diabetes. Several mechanisms are proposed to explain the improvement in glucose metabolism after RYGB surgery: the caloric restriction and weight loss per se, the improvement in insulin resistance and beta cell function, and finally the alterations in the various gastrointestinal hormones and adipokines that have been shown to play an important role in glucose homeostasis. However, the timing, exact changes of these hormones, and the relative importance of these changes in the metabolic improvement postbariatric surgery remain to be further clarified. This paper reviews the various changes post-RYGB in adipokines and gut peptides in subjects with T2D.

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Pre-intervention clinical determinants and measured β-cell function as predictors of type 2 diabetes remission after Roux-en-Y gastric bypass surgery

10.2337/figshare.15050316 ◽

2021 ◽

Author(s):

Chanel Ligon ◽

Ankit Shah ◽

Malini Prasad ◽

Blandine Laferrère

Keyword(s):

Type 2 Diabetes ◽

Bypass Surgery ◽

Cell Function ◽

Gastric Bypass Surgery ◽

Diabetes Remission ◽

Β Cell ◽

Β Cell Function ◽

Clinical Models ◽

One Year

Background: Bariatric surgery results in improved glycemic control in individuals with type 2 diabetes. Single and clusters of clinical determinants have been identified as pre-surgery predictors of post-surgery diabetes remission. Our goal was to assess if the addition of measured pre-operative ß-cell function would improve established clinical models of prediction of diabetes remission. Methods: Pre-surgery clinical characteristics, metabolic markers, and ß-cell function after oral and intravenous (IV) glucose challenges were assessed in 73 individuals with severe obesity and type 2 diabetes and again one year after gastric bypass surgery. Single and multivariate analyses were conducted with pre-operative variables to determine best predictive models of remission. Results: Pre-surgery ß-cell glucose sensitivity, a surrogate of ß-cell function, was negatively correlated with known diabetes duration, HbA1c, insulin use, and the diabetes remission scores DiaRem and Ad-DiaRem (all p <0.001). Measured ß-cell function after oral glucose was 1.6-fold greater than after IV glucose challenge, and more strongly correlated with pre-operative clinical and metabolic characteristics. The addition of pre-operative ß-cell function to clinical models containing well-defined diabetes remission scores did not improve the model’s ability to predict diabetes remission post-RYGB. Conclusions: The addition of measured β-cell function does not add predictive value to defined clinical models of diabetes remission one year after surgical weight loss.

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Pre-intervention clinical determinants and measured β-cell function as predictors of type 2 diabetes remission after Roux-en-Y gastric bypass surgery

10.2337/figshare.15050316.v1 ◽

2021 ◽

Author(s):

Chanel Ligon ◽

Ankit Shah ◽

Malini Prasad ◽

Blandine Laferrère

Keyword(s):

Type 2 Diabetes ◽

Bypass Surgery ◽

Cell Function ◽

Gastric Bypass Surgery ◽

Diabetes Remission ◽

Β Cell ◽

Β Cell Function ◽

Clinical Models ◽

One Year

Background: Bariatric surgery results in improved glycemic control in individuals with type 2 diabetes. Single and clusters of clinical determinants have been identified as pre-surgery predictors of post-surgery diabetes remission. Our goal was to assess if the addition of measured pre-operative ß-cell function would improve established clinical models of prediction of diabetes remission. Methods: Pre-surgery clinical characteristics, metabolic markers, and ß-cell function after oral and intravenous (IV) glucose challenges were assessed in 73 individuals with severe obesity and type 2 diabetes and again one year after gastric bypass surgery. Single and multivariate analyses were conducted with pre-operative variables to determine best predictive models of remission. Results: Pre-surgery ß-cell glucose sensitivity, a surrogate of ß-cell function, was negatively correlated with known diabetes duration, HbA1c, insulin use, and the diabetes remission scores DiaRem and Ad-DiaRem (all p <0.001). Measured ß-cell function after oral glucose was 1.6-fold greater than after IV glucose challenge, and more strongly correlated with pre-operative clinical and metabolic characteristics. The addition of pre-operative ß-cell function to clinical models containing well-defined diabetes remission scores did not improve the model’s ability to predict diabetes remission post-RYGB. Conclusions: The addition of measured β-cell function does not add predictive value to defined clinical models of diabetes remission one year after surgical weight loss.

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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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Common Risk Factors in Relatives and Spouses of Patients with Type 2 Diabetes in Developing Prediabetes

Healthcare ◽

10.3390/healthcare9081010 ◽

2021 ◽

Vol 9 (8) ◽

pp. 1010

Author(s):

Wei-Hao Hsu ◽

Chin-Wei Tseng ◽

Yu-Ting Huang ◽

Ching-Chao Liang ◽

Mei-Yueh Lee ◽

...

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Type 2 Diabetes ◽

Insulin Sensitivity ◽

Cell Function ◽

Diabetic Patients ◽

Β Cell ◽

Tyg Index ◽

Β Cell Function

Prediabetes should be viewed as an increased risk for diabetes and cardiovascular disease. In this study, we investigated its prevalence among the relatives and spouses of patients with type 2 diabetes or risk factors for prediabetes, insulin resistance, and β-cell function. A total of 175 individuals were included and stratified into three groups: controls, and relatives and spouses of type 2 diabetic patients. We compared clinical characteristics consisting of a homeostatic model assessment for insulin resistance (HOMA-IR) and beta cell function (HOMA-β), a quantitative insulin sensitivity check index (QUICKI), and triglyceride glucose (TyG) index. After a multivariable linear regression analysis, the relative group was independently correlated with high fasting glucose, a high TyG index, and low β-cell function; the relatives and spouses were independently associated with a low QUICKI. The relatives and spouses equally had a higher prevalence of prediabetes. These study also indicated that the relatives had multiple factors predicting the development of diabetes mellitus, and that the spouses may share a number of common environmental factors associated with low insulin sensitivity.

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