Time Course of Metabolic, Neuroendocrine, and Adipose Effects During 2 Years of Follow-up After Gastric Bypass in Patients With Type 2 Diabetes

Figure 1.. Inflammatory, hormonal and lipolysis measures. Fasting morning levels of (A) insulin, (B) IGF-1, (C) ACTH, (D) cortisol, (E) CRP, (F) WBC, (G) FFAs, and (H) glycerol at baseline and at 4, 24, and 104 weeks after RYGB. Data are expressed as means ± SD. P-values from pairwise comparison with baseline, after using mixed effects model, corrected for false detection rate. *P < 0.05, ***P < 0.01, ***P < 0.001.

Figure 2.. Adipocyte morphology after RYGB. (A) Average adipocyte volumes shown in picoliters (pL; means ± SEM, horizontal lines) for baseline, post-LCD, 4 weeks, 24 weeks, 104 weeks and controls, respectively (n = 12, 12, 10, 12, 11, and 22, respectively). *P < 0.05, ***P < 0.001 vs baseline; ##P < 0.01 for controls vs 104 weeks. (B) Representative images of adipocyte size from 1 subject at different study visits. All images and measurements were obtained using a light microscope with a magnification of ×100.

Figure 3.. Adipocyte glucose uptake after RYGB. Basal and insulin-stimulated glucose uptake in isolated adipocytes. (A) Adjusted for number of cells; (B) adjusted for cell surface area. Data are shown as means ± SEM. **P < 0.01; ***P < 0.001 vs baseline. Abbreviation: NS, nonsignificant for controls vs 104 weeks.

Figure 4.. Adipocyte lipolysis after RYGB. (A) Isolated adipocytes were incubated without hormones or (B) with isoproterenol 0.5 µM together with different concentrations of insulin (0-100 µU/mL), and glycerol release was measured. Data are means ± SEM, and there were no significant differences (baseline vs post-LCD, 4 weeks, 24 weeks, and 104 weeks postsurgery; n = 12, 7, 10, 12, and 8, respectively, due to limited tissue amounts).

Figure 5.. Schematic and hypothetical overview of changes after RYGB as they occur over time. Grey arrows, clinical effects; white arrows, effects on endocrine, autonomic nerve, and adipose functions, which may contribute to the favorable clinical effects.