Glucose Metabolism After Gastric Banding and Gastric Bypass in Individuals With Type 2 Diabetes: Weight Loss Effect

Gastric bypass leads to the remission of type 2 diabetes independently of weight loss. Our hypothesis is that changes in bile flow due to the altered anatomy may partly explain the metabolic outcomes of the operation. We prospectively studied 12 patients undergoing gastric bypass and six patients undergoing gastric banding over a 6-wk period. Plasma fibroblast growth factor (FGF)19, stimulated by bile acid absorption in the terminal ileum, and plasma bile acids were measured. In canine and rodent models, we investigated changes in the gut hormone response after altered bile flow. FGF19 and total plasma bile acids levels increased after gastric bypass compared with no change after gastric banding. In the canine model, both food and bile, on their own, stimulated satiety gut hormone responses. However, when combined, the response was doubled. In rats, drainage of endogenous bile into the terminal ileum was associated with an enhanced satiety gut hormone response, reduced food intake, and lower body weight. In conclusion, after gastric bypass, bile flow is altered, leading to increased plasma bile acids, FGF19, incretin. and satiety gut hormone concentrations. Elucidating the mechanism of action of gastric bypass surgery may lead to novel treatments for type 2 diabetes.

Download Full-text

Faculty Opinions recommendation of Acute and long-term effects of Roux-en-Y gastric bypass on glucose metabolism in subjects with Type 2 diabetes and normal glucose tolerance.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717982095.793471985 ◽

2013 ◽

Author(s):

Gina LC Yosten ◽

Molly Elrick

Keyword(s):

Type 2 Diabetes ◽

Gastric Bypass ◽

Glucose Metabolism ◽

Glucose Tolerance ◽

Normal Glucose Tolerance ◽

Long Term Effects ◽

Normal Glucose

Download Full-text

Factors determining chance of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a nationwide cohort study in 8057 Swedish patients

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-002033 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002033

Author(s):

Erik Stenberg ◽

Torsten Olbers ◽

Yang Cao ◽

Magnus Sundbom ◽

Anders Jans ◽

...

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Gastric Bypass ◽

Metabolic Surgery ◽

First Generation ◽

Hemoglobin A1c ◽

Diabetes Remission ◽

Factors Associated ◽

Generation Immigrant

IntroductionBariatric and metabolic surgery is an effective treatment option for type 2 diabetes (T2D). Increased knowledge regarding factors associated with diabetes remission is essential in individual decision making and could guide postoperative care. Therefore, we aimed to explore factors known to affect the chance of achieving diabetes remission after bariatric and metabolic surgery and to further investigate the impact of socioeconomic factors.Research design and methodsIn this nationwide study, we assessed all patients with T2D who underwent Roux-en-Y gastric bypass (RYGB) surgery between 2007 and 2015 in the Scandinavian Obesity Surgery Registry. Remission was defined as absence of antidiabetic medication for T2D 2 years after surgery. Multivariable logistic regression was used to evaluate factors associated with diabetes remission, with missing data handled by multiple imputations.ResultsA total of 8057 patients were included. Mean age±SD was 47.4±10.1 years, mean body mass index 42.2±5.7 kg/m2, mean hemoglobin A1c 59.0±17.33, and 61.7% (n=4970) were women. Two years after surgery, 6211 (77.1%) patients achieved T2D remission. Preoperative insulin treatment (OR 0.26, 95% CI 0.22 to 0.30), first-generation immigrant (OR 0.66, 95% CI 0.57 to 0.77), duration of T2D (OR 0.89, 95% CI 0.88 to 0.90), dyslipidemia (OR 0.71, 95% CI 0.62 to 0.81), age (OR 0.97, 95% CI 0.96 to 0.97), and high glycosylated hemoglobin A1c (HbA1c) (OR 0.99, 95% CI 0.98 to 0.99) were all associated with lower T2D remission rate. In contrast, residence in a medium-sized (OR 1.39, 95% CI 1.20 to 1.61) or small (OR 1.46, 95% CI 1.25 to 1.71) town and percentage of total weight loss (OR 1.04, 95% CI 1.03 to 1.04) were associated with higher remission rates.ConclusionAmong patients with T2D undergoing RYGB surgery, increasing age, HbA1c, and diabetes duration decreased the chance of reaching diabetes remission without cut-offs, while postoperative weight loss demonstrated a positive linear association. In addition, being a first-generation immigrant and living in a large city were socioeconomic factors having a negative association.

Download Full-text

The Effects of Weight Loss and Gastric Banding on the Innate and Adaptive Immune System in Type 2 Diabetes and Prediabetes

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2009-2371 ◽

2010 ◽

Vol 95 (6) ◽

pp. 2845-2850 ◽

Cited By ~ 47

Author(s):

A. Viardot ◽

R. V. Lord ◽

K. Samaras

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Immune System ◽

Gastric Banding ◽

Adaptive Immune System ◽

Adaptive Immune

Download Full-text

One anastomosis gastric bypass: a way to normalize insulin secretion in patients with obesity and type 2 diabetes mellitus, regardless of clinically significant weight loss

Endoskopicheskaya khirurgiya ◽

10.17116/endoskop20212706138 ◽

2021 ◽

Vol 27 (6) ◽

pp. 38

Author(s):

I.Y. Yakovenko ◽

A.M. Mkrtumyan ◽

A.A. Botov ◽

I.B. Elagin ◽

V.V. Strusov ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Weight Loss ◽

Gastric Bypass ◽

Type 2 Diabetes Mellitus ◽

Insulin Secretion ◽

One Anastomosis Gastric Bypass ◽

Significant Weight Loss ◽

Clinically Significant

Download Full-text

Reported appetite, taste and smell changes following Roux-en-Y gastric bypass and sleeve gastrectomy: Effect of gender, type 2 diabetes and relationship to post-operative weight loss

Appetite ◽

10.1016/j.appet.2016.07.029 ◽

2016 ◽

Vol 107 ◽

pp. 93-105 ◽

Cited By ~ 36

Author(s):

Janine M. Makaronidis ◽

Sabrina Neilson ◽

Wui-Hang Cheung ◽

Urszula Tymoszuk ◽

Andrea Pucci ◽

...

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Taste And Smell ◽

Gender Type

Download Full-text

Type 2 Diabetes Remission Rates After Laparoscopic Gastric Bypass and Gastric Banding: Results of the Longitudinal Assessment of Bariatric Surgery Study

Diabetes Care ◽

10.2337/dc15-2138 ◽

2016 ◽

Vol 39 (7) ◽

pp. 1101-1107 ◽

Cited By ~ 72

Author(s):

Jonathan Q. Purnell ◽

Faith Selzer ◽

Abdus S. Wahed ◽

John Pender ◽

Walter Pories ◽

...

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Gastric Bypass ◽

Gastric Banding ◽

Laparoscopic Gastric Bypass ◽

Diabetes Remission ◽

Longitudinal Assessment ◽

Remission Rates ◽

Type 2 Diabetes Remission

Download Full-text

Role of Gut-Related Peptides and Other Hormones in the Amelioration of Type 2 Diabetes after Roux-en-Y Gastric Bypass Surgery

ISRN Endocrinology ◽

10.5402/2012/504756 ◽

2012 ◽

Vol 2012 ◽

pp. 1-13 ◽

Cited By ~ 14

Author(s):

Mirella P. Hage ◽

Bassem Safadi ◽

Ibrahim Salti ◽

Mona Nasrallah

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Gastric Bypass ◽

Bypass Surgery ◽

Cell Function ◽

Gastric Bypass Surgery ◽

Gastrointestinal Hormones ◽

Gut Peptides

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.

Download Full-text

Dual Mechanism for Type-2 Diabetes Resolution after Roux-en-Y Gastric Bypass

The American Surgeon ◽

10.1177/000313480907500608 ◽

2009 ◽

Vol 75 (6) ◽

pp. 498-503 ◽

Cited By ~ 10

Author(s):

Edward Lin ◽

S. Scott Davis ◽

Jahnavi Srinivasan ◽

John F. Sweeney ◽

Thomas R. Ziegler ◽

...

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Weight Loss ◽

Gastric Bypass ◽

Insulin Secretion ◽

Glucose Tolerance ◽

Cell Function ◽

Β Cell ◽

Peripheral Insulin Resistance

Resolution of Type-2 diabetes mellitus (DM) after weight loss surgery is well documented, but the mechanism is elusive. We evaluated the glucose-insulin metabolism of patients undergoing a Roux-en-Y gastric bypass (RYGB) using the intravenous glucose tolerance test (IVGTT) and compared it with patients who underwent laparoscopic adjustable gastric band (AB) placement. Thirty-one female patients (age range, 20 to 50 years; body mass index, 47.2 kg/m2) underwent RYGB. Nine female patients underwent AB placement and served as control subjects. All patients underwent IVGTT at baseline and 1 month and 6 months after surgery. Thirteen patients undergoing RYGB and one patient undergoing AB exhibited impaired glucose tolerance or DM defined by the American Diabetes Association. By 6 months post surgery, diabetes was resolved in all but one patient undergoing RYGB but not in the patient undergoing AB. Patients with diabetes undergoing RYGB demonstrated increased insulin secretion and β-cell responsiveness 1 month after surgery and continued this trend up to 6 months, whereas none of the patients undergoing AB had changes in β-cell function. Both patients undergoing RYGB and those undergoing AB demonstrated significant weight loss (34.6 and 35.0 kg/m2, respectively) and improved insulin sensitivity at 6 months. RYGB ameliorates DM resolution in two phases: 1) early augmentation of beta cell function at 1 month; and 2) attenuation of peripheral insulin resistance at 6 months. Patients undergoing AB only exhibited reduction in peripheral insulin resistance at 6 months but no changes in insulin secretion.

Download Full-text