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GLP-1 and the Long-Term Outcome of Type 2 Diabetes Mellitus After Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Subjects

Jiménez, Amanda MD*; Casamitjana, Roser PhD*,†,‡; Flores, Lílliam MD, PhD*,†,‡; Delgado, Salvadora MD, PhD*; Lacy, Antonio MD, PhD*,‡; Vidal, Josep MD, PhD*,†,‡

doi: 10.1097/SLA.0b013e31826b8603
Original Articles

Objective: To evaluate the association between glucagon-like peptide 1 (GLP-1) secretion and the long-term (>2 years) outcome of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGBP).

Methods: Cross-sectional study in 18 T2DM morbidly obese subjects who underwent RYGBP but differed in the long-term outcome of T2DM (remission: G1, n = 6; relapse: G2, n = 6; lack of remission: G3: n = 6). Groups were matched for their sex, age, and body mass index. The GLP-1, glucose, C-peptide, and glucagon responses to a standardized test meal (STM) were evaluated. Insulin secretion and insulin sensitivity were estimated from the STM and by frequently sampling intravenous glucose tolerance test (FSIVGTT). Dual-energy X-ray absorptiometry was used to assess body composition.

Results: Patients in G1 presented a lower area under the curve (AUC0–120) of glucose in response to the STM as compared with G2, and G3 (P < 0.01). In contrast, the AUC0–120 of GLP-1 (P = 0.884) and glucagon (P = 0.630) did not differ significantly among the 3 groups. Indices of insulin secretion adjusted by the prevailing insulin sensitivity derived from STM and FSIVGTT, demonstrated larger β-cell function in subjects in G1 as compared with G2 or G3 (Disposition Index-STM, P = 0.005; DI-FSIVGTT, P = 0.006). Body composition and inflammatory markers did not differ significantly among the 3 study groups.

Conclusions: Our data show that in subjects with T2DM an enhanced GLP-1 response to meal intake is not sufficient to maintain normal glucose tolerance in the long term after RYGBP. Our data suggest that β-cell function is a key determinant of the long-term remission of T2DM after this bariatric surgery technique.

In patients with type 2 diabetes mellitus (T2DM) before surgery, Roux-en-Y gastric bypass (RYGBP) is associated with an enhanced glucagon-like peptide 1 (GLP-1) response to meal intake in the long term after surgery. However, the enlarged GLP-1 response is not necessarily associated with remission of the T2DM. In contrast, our data suggest that β-cell function is an important factor in determining long-term remission of T2DM after RYGBP.

*Obesity Unit, Hospital Clinic Universitari

Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)

Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.

Reprints: Josep Vidal, MD, PhD, Obesity Unit, Endocrinology and Diabetes Department, Hospital Clínic Universitari, Villarroel 170, 08036 Barcelona, Spain. E-mail: jovidal@clinic.ub.es.

Disclosure: This work was supported by grants from the Fundación Mutua Madrileña (AP62572009), and Instituto de Salud Carlos III (PI011/00892), Madrid, Spain.

© 2013 by Lippincott Williams & Wilkins.