학술논문
Gastrointestinal Hormones and [beta]-Cell Function After Gastric Bypass and Sleeve Gastrectomy: A Randomized Controlled Trial (Oseberg)
Clinical Research Article
Clinical Research Article
Document Type
Clinical report
Author
Source
Journal of Clinical Endocrinology & Metabolism. February 2022, Vol. 107 Issue 2, pe756, 11 p.
Subject
Language
English
ISSN
0021-972X
Abstract
Bariatric surgery significantly improves glycemic control in patients with obesity and type 2 diabetes (1). Further, both Roux-en-Y gastric bypass and sleeve gastrectomy, the most frequently applied bariatric procedures worldwide, [...]
Context: Whether Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differentially affect postprandial gastrointestinal hormones and [beta]-cell function in type 2 diabetes remains unclear. Objective: We aimed to compare gastrointestinal hormones and [beta]-cell function, assessed by an oral glucose tolerance test (OGTT) 5 weeks and 1 year after surgery, hypothesizing higher glucagon-like peptide-1 (GLP-1) levels and greater [beta]-cell response to glucose after RYGB than after SG. Methods: This study was a randomized, triple-blind, single-center trial at a tertiary care center in Norway. The primary outcomes were diabetes remission and IVGTT-derived [beta]-cell function. Participants with obesity and type 2 diabetes were allocated (1:1) to RYGB or SG. We measured gastrointestinal hormone profiles and insulin secretion as [beta]-cell glucose sensitivity ([beta]-GS) derived from 180-minute OGTTs. Results: Participants were 106 patients (67% women), mean (SD) age 48 (10) years. Diabetes remission rates at 1 year were higher after RYGB than after SG (77% vs 48%; P = 0.002). Incremental area under the curve ([iAUC.sub.0-180]) GLP-1 and [beta]-GS increased more after RYGB than after SG, with 1-year between-group difference 1173 pmol/L*min (95% CI, 569-1776; P= 0.0010) and 0.45 pmol/kg/min/mmol (95% CI, 0.15-0.75; P= 0.0032), respectively. After surgery, fasting and postprandial ghrelin levels were higher and decremental [AUC.sub.0-180] ghrelin, [iAUC.sub.0-180] glucose-dependent insulinotropic polypeptide, and [iAUC.sub.0-60] glucagon were greater after RYGB than after SG. Diabetes remission at 1 year was associated with higher [beta]-GS and higher GLP-1 secretion. Conclusion: RYGB was associated with greater improvement in [beta]-cell function and higher postprandial GLP-1 levels than SG. Key Words: gastric bypass, sleeve gastrectomy, gastrointestinal hormones, glucagon-like peptide 1, type 2 diabetes, obesity
Context: Whether Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differentially affect postprandial gastrointestinal hormones and [beta]-cell function in type 2 diabetes remains unclear. Objective: We aimed to compare gastrointestinal hormones and [beta]-cell function, assessed by an oral glucose tolerance test (OGTT) 5 weeks and 1 year after surgery, hypothesizing higher glucagon-like peptide-1 (GLP-1) levels and greater [beta]-cell response to glucose after RYGB than after SG. Methods: This study was a randomized, triple-blind, single-center trial at a tertiary care center in Norway. The primary outcomes were diabetes remission and IVGTT-derived [beta]-cell function. Participants with obesity and type 2 diabetes were allocated (1:1) to RYGB or SG. We measured gastrointestinal hormone profiles and insulin secretion as [beta]-cell glucose sensitivity ([beta]-GS) derived from 180-minute OGTTs. Results: Participants were 106 patients (67% women), mean (SD) age 48 (10) years. Diabetes remission rates at 1 year were higher after RYGB than after SG (77% vs 48%; P = 0.002). Incremental area under the curve ([iAUC.sub.0-180]) GLP-1 and [beta]-GS increased more after RYGB than after SG, with 1-year between-group difference 1173 pmol/L*min (95% CI, 569-1776; P= 0.0010) and 0.45 pmol/kg/min/mmol (95% CI, 0.15-0.75; P= 0.0032), respectively. After surgery, fasting and postprandial ghrelin levels were higher and decremental [AUC.sub.0-180] ghrelin, [iAUC.sub.0-180] glucose-dependent insulinotropic polypeptide, and [iAUC.sub.0-60] glucagon were greater after RYGB than after SG. Diabetes remission at 1 year was associated with higher [beta]-GS and higher GLP-1 secretion. Conclusion: RYGB was associated with greater improvement in [beta]-cell function and higher postprandial GLP-1 levels than SG. Key Words: gastric bypass, sleeve gastrectomy, gastrointestinal hormones, glucagon-like peptide 1, type 2 diabetes, obesity