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Time course of meta...
Time course of metabolic, neuroendocrine, and adipose effects during 2 years of follow-up after gastric bypass in patients with type 2 diabetes
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- Almby, Kristina E. (författare)
- Uppsala universitet,Klinisk diabetologi och metabolism
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- Katsogiannos, Petros, 1979- (författare)
- Uppsala universitet,Klinisk diabetologi och metabolism
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- Pereira, Maria J., 1981- (författare)
- Uppsala universitet,Klinisk diabetologi och metabolism
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- Karlsson, Anders, 1945- (författare)
- Uppsala universitet,Klinisk diabetologi och metabolism
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- Sundbom, Magnus (författare)
- Uppsala universitet,Gastrointestinalkirurgi
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- Wiklund, Urban (författare)
- Umeå universitet,Radiofysik,Umeå Univ, Dept Radiat Sci, Umeå, Sweden.
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- Kamble, Prasad G. (författare)
- Uppsala universitet,Klinisk diabetologi och metabolism
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- Eriksson, Jan (författare)
- Uppsala universitet,Klinisk diabetologi och metabolism
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(creator_code:org_t)
- 2021-06-04
- 2021
- Engelska.
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : Oxford University Press. - 0021-972X .- 1945-7197. ; 106:10, s. E4049-E4061
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Abstract
Ämnesord
Stäng
- Context: Roux-en-Y gastric bypass surgery (RYGB) markedly improves glycemia in patients with type 2 diabetes (T2D), but underlying mechanisms and changes over time are incompletely understood.Objective: Integrated assessment of neuroendocrine and metabolic changes over time inT2D patients undergoing RYGB.Design and Setting: Follow-up of single-center randomized study.Patients: Thirteen patients with obesity andT2D compared to 22 healthy subjects.Interventions: Blood chemistry, adipose biopsies, and heart rate variability were obtained before and 4, 24, and 104 weeks post-RYGB.Results: After RYGB, glucose-lowering drugs were discontinued and hemoglobin A1c fell from mean 55 to 41 mmol/mol by 104 weeks (P < 0.001). At 4 weeks, morning cortisol (P < 0.05) and adrenocorticotropin (P = 0.09) were reduced by 20%. Parasympathetic nerve activity (heart rate variability derived) increased at 4 weeks (P < 0.05) and peaked at 24 weeks (P < 0.01). C-reactive protein (CRP) and white blood cells were rapidly reduced (P < 0.01). At 104 weeks, basal and insulin-stimulated adipocyte glucose uptake increased by 3-fold vs baseline and expression of genes involved in glucose transport, fatty acid oxidation, and adipogenesis was upregulated (P < 0.01). Adipocyte volume was reduced by 4 weeks and more markedly at 104 weeks, by about 40% vs baseline (P < 0.01).Conclusions: We propose this order of events: (1) rapid glucose lowering (days); (2) attenuated cortisol axis activity and inflammation and increased parasympathetic tone (weeks); and (3) body fat and weight loss, increased adipose glucose uptake, and whole-body insulin sensitivity (months-years; similar to healthy controls).Thus, neuroendocrine pathways can partly mediate early glycemic improvement after RYGB, and adipose factors may promote long-term insulin sensitivity and normoglycemia.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
Nyckelord
- Adipose effects
- Neuroendocrine changes
- RYGB
- T2D
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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