Roux-en-Y gastric bypass and sleeve gastrectomy resulted in similar 1-year type 2 diabetes remission rates (56.5% vs 58.3%), predicted by baseline β-cell glucose sensitivity and GLP-1 response.
Cohort (n=35)
Do Roux-en-Y gastric bypass and sleeve gastrectomy improve beta-cell function and insulin sensitivity in obese patients with type 2 diabetes?
Baseline β-cell glucose sensitivity and restored GLP-1 response are the chief determinants of diabetes remission following bariatric surgery.
Absolute Event Rate: 56.5% vs 58.3%
CONTEXT: In obese patients with type 2 diabetes (T2DM), Roux-en-Y-gastric-bypass (RYGB) and sleeve gastrectomy (SLG) improve glycemic control. OBJECTIVE: The objective of this study was to investigate the mechanisms of surgery-induced T2DM improvement and role of gastrointestinal hormones. PATIENTS, SETTING, AND INTERVENTION: In 35 patients with T2DM, we performed a mixed-meal test before and 15 days and 1 year after surgery (23 RYGB and 12 SLG). MAIN OUTCOME MEASURES: Insulin sensitivity, β-cell function, and amylin, ghrelin, PYY, pancreatic polypeptide (PP), glucagon, and glucagon-like peptide-1 (GLP-1) responses to the meal were measured. RESULTS: T2DM remission occurred in 13 patients undergoing RYGB and in 7 patients undergoing SLG. Similarly in the RYGB and SLG groups, β-cell glucose sensitivity improved both early and long term (P < .005), whereas insulin sensitivity improved long term only (P < .006), in proportion to body mass index changes (P < .001). Early after RYGB, glucagon and GLP-1 responses to the meal increased, whereas the PP response decreased. At 1 year, PYY was increased, and PP, amylin, ghrelin, and GLP-1 were reduced. After SLG, hormonal responses were similar to those with RYGB except that PP was increased, whereas amylin was unchanged. In remitters, fasting GLP-1 was higher (P = .04), but its meal response was flat compared with that of nonremitters; postsurgery, however, the GLP-1 response was higher. Other hormone responses were similar between the 2 groups. In logistic regression, presurgery β-cell glucose sensitivity (positive, P < .0001) and meal-stimulated GLP-1 response (negative, P = .004) were the only predictors of remission. CONCLUSIONS: RYGB and SLG have a similar impact on diabetes remission, of which baseline β-cell glucose sensitivity and a restored GLP-1 response are the chief determinants. Other hormonal responses are the consequences of the altered gastrointestinal anatomy.
Nannipieri et al. (2013) conducted a cohort in Type 2 diabetes and obesity (n=35). Roux-en-Y gastric bypass (RYGB) vs. Sleeve gastrectomy (SLG) was evaluated on Type 2 diabetes remission. Roux-en-Y gastric bypass and sleeve gastrectomy resulted in similar 1-year type 2 diabetes remission rates (56.5% vs 58.3%), predicted by baseline β-cell glucose sensitivity and GLP-1 response.