Key result
RYGB improves peripheral glucose uptake at six months, driven by substantial weight loss.
Why the study?
The independent effects of weight loss and hormonal secretion on peripheral glucose disposal after Roux-en-Y gastric bypass are unknown.
Does Roux-en-Y gastric bypass followed by caloric restriction improve peripheral glucose disposal compared to caloric restriction alone in nondiabetic morbidly obese patients?
RCT (n=22)
Open-label
Partial randomization (first 17 randomized, last 5 by availability)
No
Does Roux-en-Y gastric bypass followed by caloric restriction improve peripheral glucose disposal compared to caloric restriction alone in nondiabetic morbidly obese patients?
Improvement in peripheral glucose uptake after Roux-en-Y gastric bypass appears to be driven by the magnitude of weight loss rather than early postoperative hormonal changes.
Answers are grounded in this paper and cite their sources.
Peripheral glucose disposal improves only after substantial weight loss post-RYGB; supports weight loss as primary driver but requires confirmation in larger trials.
INTRODUCTION: Altered gut and pancreatic hormone secretion may bolster resolution of insulin resistance after Roux-en-Y gastric bypass (RYGB), but the independent effects of weight loss and hormonal secretion on peripheral glucose disposal are unknown. METHODS: Two groups of nondiabetic morbidly obese patients were studied: RYGB followed by standardized caloric restriction (RYGB, n = 12) or caloric restriction alone (diet, n = 10). Metabolic evaluations (euglycemic-hyperinsulinemic clamp, meal tolerance test) were done at baseline and 14 days (both groups) and 6 months after RYGB. RESULTS: At baseline, body composition, fasting insulin, and glucose and peripheral glucose disposal did not differ between groups. At 14 days, excess weight loss (EWL) was similar (RYGB, 12.7% vs. diet, 10.9%; p = 0.12), fasting insulin and glucose decreased to a similar extent, and RYGB subjects had altered postmeal patterns of gut and pancreatic hormone secretion. However, peripheral glucose uptake (M value) was unchanged in both groups. Six months after RYGB, EWL was 49.7%. The changes in fasting glucose and insulin levels and gut hormone secretion persisted. M values improved significantly, and changes in M values correlated with the % EWL (r = 0.68, p = 0.02). CONCLUSIONS: Improvement in peripheral glucose uptake following RYGB was observed only after substantial weight loss had occurred and correlated with the magnitude of weight lost.
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Campos et al. (2009) conducted an RCT in Morbid obesity (nondiabetic) (n=22). Roux-en-Y gastric bypass (RYGB) followed by caloric restriction vs. Caloric restriction alone was evaluated on Correlation between change in peripheral glucose uptake (M value) and percent excess weight loss at 6 months (r=0.68, p=0.02). Improvement in peripheral glucose uptake following Roux-en-Y gastric bypass was observed only after substantial weight loss had occurred at 6 months and significantly correlated with the magnitude of weight lost (r=0.68, p=0.02).
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