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Improved glucose me...
Improved glucose metabolism after gastric bypass: evolution of the paradigm
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Pournaras, D. J. (författare)
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- Nygren, J. (författare)
- Karolinska Institutet
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Hagstrom-Toft, E. (författare)
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- Arner, P. (författare)
- Karolinska Institutet
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- le Roux, Carel W (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för gastrokirurgisk forskning och utbildning,Institute of Clinical Sciences, Department of Gastrosurgical Research and Education
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- Thorell, A. (författare)
- Karolinska Institutet
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(creator_code:org_t)
- Elsevier BV, 2016
- 2016
- Engelska.
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 12:8, s. 1457-1465
- Relaterad länk:
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Background: Glucose metabolism is improved in patients with type 2 diabetes after Roux-en-Y gastric bypass (RYGB). Objectives: To quantify the relative contribution of calorie restriction, rerouting of nutrients, and adipose tissue reduction. Methods: Fifteen diabetic patients, (47 +/- 9 yr, body mass index 41.3 +/- 4.2 kg/m(2)) were randomized to a 2-week very low-calorie diet (VLCD) regimen or normal diet before RYGB. A euglycemic-hyperinsulinemic clamp, indirect calorimetry, and a standard meal test were performed prediet, postdiet (preoperatively), and 2 weeks and 12 months postoperatively. The primary outcome was whole-body insulin sensitivity (M) measured with the clamp 2 weeks postoperatively. Results: In the VLCD group, after 2 weeks of calorie restriction, M improved (2.9 +/- 1.3 to 4.2 +/- 1.1 mg/kg/min, P = .005) with no further change at 2 weeks postoperatively. In the normal diet group 2 weeks postoperatively, M was similar to the VLCD group (4.7 +/- 1.7 versus 4.2 +/- 1.1, P = .61). One year postoperatively, M improved further in both groups. The improvement in insulin-stimulated glucose uptake after VLCD and RYGB was entirely accounted for by nonoxidative glucose disposal (NOGD), whereas weight loss at 1 year postoperatively was associated with an increase in NOGD and glucose oxidation. Postprandial glucose improved after VLCD (P < .05) and even more 2 weeks after RYGB (P < .05) with no further change after 1 year. Conclusion: Improved whole-body insulin sensitivity and postprandial glucose response occur early after RYGB. Low calorie intake and rerouting of nutrients contribute through distinct mechanisms. Weight loss contributes by increasing whole-body insulin sensitivity, including glucose oxidation and NOGD. These data suggest that the combination of different mechanisms is what makes RYGB an effective intervention for type 2 diabetes. (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Gastroenterologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)
Nyckelord
- Diabetes mellitus type 2
- Obesity
- Insulin resistance
- Glucose clamp technique
- Bariatric surgery
- Gastric bypass
- Randomized controlled trial
- beta-cell function
- substrate oxidation rates
- low-calorie diet
- weight-loss
- insulin sensitivity
- bariatric surgery
- medical therapy
- obese-patients
- resistance
- management
- Surgery
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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