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Effects of Roux-en-Y Gastric Bypass or Diabetes Support and Education on Insulin Sensitivity and Insulin Secretion in Morbidly Obese Patients With Type 2 Diabetes

Khoo, Chin Meng MD*,†; Chen, Jiegen PhD*,‡; Pamuklar, Zehra MD, PhD*,‡; Torquati, Alfonso MD, MSCI*,‡

Annals of Surgery:
doi: 10.1097/SLA.0b013e318294d19c
Original Articles
Abstract

Objective: The long-term changes in insulin sensitivity and β-cell function in morbidly obese patients with type 2 diabetes mellitus who undergo Roux-en-Y gastric bypass (RYGB) surgery or standard medical care remain unclear. We prospectively studied longitudinal changes of glucostatic parameters in morbidly obese patients with type 2 diabetes mellitus undergoing RYGB surgery or diabetes support and education (DSE).

Research Methods and Design: Sixty-one morbidly obese subjects (41.7 ± 0.6 kg/m2) with type 2 diabetes mellitus were assigned to RYGB surgery (n = 30) or DSE (n = 31). They were matched for sex, age, and body weight. Insulin sensitivity index (Si) and acute insulin response (AIR) were derived from frequently sampled intravenous glucose tolerance test. Body composition was measured using dual-energy x-ray absorptiometry. General linear model with repeated measures was used to examine the longitudinal changes (baseline, 6 months, 12 months) in these parameters.

Results: At 12-month follow-up, significant improvement in obesity measures, body composition, glucose homeostasis, Si, and AIR was observed after RYGB surgery and weight loss. These outcomes were not influenced by preoperative insulin use. Although there were no significant changes in the body composition among DSE subjects, they experienced a decline in the Si and AIR, along with an increase in fasting glucose and HbA1c. The between-group differences in Si and AIR at 12-month follow-up were completely attenuated with adjustment to changes in body weight.

Conclusions: The long-term effects of RYGB surgery on glucostatic parameters are partly dependent on weight loss. In morbidly obese patients with diabetes who were offered DSE, a progressive decline in the glucose homeostasis and glucostatic parameters is observed despite absence of weight gain. (NCT00787670)

In Brief

We prospectively studied longitudinal changes of glucostatic parameters in morbidly obese patients with type 2 diabetes mellitus undergoing Roux-en-Y gastric bypass (RYGB) surgery or diabetes support and education (DSE). At 12-month follow-up, significant improvement in obesity measures, body composition, glucose homeostasis, insulin sensitivity index, and acute insulin response was observed after RYGB surgery but not after DSE.

Author Information

*Sarah W. Stedman Nutrition & Metabolism Center, Duke University Medical Center, Durham, NC

Department of Medicine, National University Health System, Singapore; and

Department of General Surgery, Duke University Medical Center, Durham, NC.

Reprints: Alfonso Torquati MD, MSCI, Duke Center for Metabolic and Weight Loss Surgery, and Sarah W. Stedman Nutrition & Metabolism Center, 407 Crutchfield Road, Durham, NC 27704. E-mail: alfonso.torquati@duke.edu.

Supported by NIH Grant K23 DK075907 to AT.

Disclosure: The authors declare that there is no duality of interest associated with this manuscript. The authors declare no conflicts of interest.

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© 2014 by Lippincott Williams & Wilkins.