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Incretin Levels and Effect Are Markedly Enhanced 1 Month After Roux-en-Y Gastric Bypass Surgery in Obese Patients With Type 2 Diabetes

¹ Obesity Research Center, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York
² Bariatric Division, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York

Address correspondence and reprint requests to Blandine Laferrère, MD, Obesity Research Center, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1111 Amsterdam Ave., New York, NY 10025. E-mail: bbl14{at}columbia.edu

OBJECTIVE— Limited data on patients undergoing Roux-en-Y gastric bypass surgery (RY-GBP) suggest that an improvement in insulin secretion after surgery occurs rapidly and thus may not be wholly accounted for by weight loss. We hypothesized that in obese patients with type 2 diabetes the impaired levels and effect of incretins changed as a consequence of RY-GBP.

RESEARCH DESIGN AND METHODS— Incretin (gastric inhibitory peptide [GIP] and glucagon-like peptide-1 [GLP-1]) levels and their effect on insulin secretion were measured before and 1 month after RY-GBP in eight obese women with type 2 diabetes and in seven obese nondiabetic control subjects. The incretin effect was measured as the difference in insulin secretion (area under the curve [AUC]) in response to an oral glucose tolerance test (OGTT) and to an isoglycemic intravenous glucose test.

RESULTS— Fasting and stimulated levels of GLP-1 and GIP were not different between control subjects and patients with type 2 diabetes before the surgery. One month after RY-GBP, body weight decreased by 9.2 ± 7.0 kg, oral glucose-stimulated GLP-1 (AUC) and GIP peak levels increased significantly by 24.3 ± 7.9 pmol · l^–1 · min^–1 (P < 0.0001) and 131 ± 85 pg/ml (P = 0.007), respectively. The blunted incretin effect markedly increased from 7.6 ± 28.7 to 42.5 ± 11.3 (P = 0.005) after RY-GBP, at which it time was not different from that for the control subjects (53.6 ± 23.5%, P = 0.284).

CONCLUSIONS— These data suggest that early after RY-GBP, greater GLP-1 and GIP release could be a potential mediator of improved insulin secretion.

Abbreviations: AUC, area under the curve • BPD, biliopancreatic diversion • DPPIV, dipeptidyl-peptidase IV • GIP, gastric inhibitory peptide • GLP-1, glucagon-like peptide-1 • IsoG IVGT, isoglycemic intravenous glucose test • IV, intravenous • JIB, jejunoileal bypass • OGTT, oral glucose tolerance test • RY-GBP, Roux-en-Y gastric bypass surgery

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