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Effects of Diet versus Gastric Bypass on Metabolic Function in Diabetes
Open accessAbstract
BACKGROUND: Some studies have suggested that in people with type 2 diabetes, Roux-en-Y gastric bypass has therapeutic effects on metabolic function that are independent of weight loss. METHODS: We evaluated metabolic regulators of glucose homeostasis before and after matched (approximately 18%) weight loss induced by gastric bypass (surgery group) or diet alone (diet group) in 22 patients with obesity and diabetes. The primary outcome was the change in hepatic insulin sensitivity, assessed by infusion of insulin at low rates (stages 1 and 2 of a 3-stage hyperinsulinemic euglycemic pancreatic clamp). Secondary outcomes were changes in muscle insulin sensitivity, beta-cell function, and 24-hour plasma glucose and insulin profiles. RESULTS: Weight loss was associated with increases in mean suppression of glucose production from baseline, by 7.04 μmol per kilogram of fat-free mass per minute (95% confidence interval [CI], 4.74 to 9.33) in the diet group and by 7.02 μmol per kilogram of fat-free mass per minute (95% CI, 3.21 to 10.84) in the surgery group during clamp stage 1, and by 5.39 (95% CI, 2.44 to 8.34) and 5.37 (95% CI, 2.41 to 8.33) μmol per kilogram of fat-free mass per minute in the two groups, respectively, during clamp stage 2; there were no significant differences between the groups. Weight loss was associated with increased insulin-stimulated glucose disposal, from 30.5±15.9 to 61.6±13.0 μmol per kilogram of fat-free mass per minute in the diet group and from 29.4±12.6 to 54.5±10.4 μmol per kilogram of fat-free mass per minute in the surgery group; there was no significant difference between the groups. Weight loss increased beta-cell function (insulin secretion relative to insulin sensitivity) by 1.83 units (95% CI, 1.22 to 2.44) in the diet group and by 1.11 units (95% CI, 0.08 to 2.15) in the surgery group, with no significant difference between the groups, and it decreased the areas under the curve for 24-hour plasma glucose and insulin levels in both groups, with no significant difference between the groups. No major complications occurred in either group. CONCLUSIONS: In this study involving patients with obesity and type 2 diabetes, the metabolic benefits of gastric bypass surgery and diet were similar and were apparently related to weight loss itself, with no evident clinically important effects independent of weight loss. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT02207777.).
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“Caloric restriction can rapidly reduce steatosis and hepatic insulin resistance [41][42][43].”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [43]
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“In people with type 2 diabetes, weight loss after bariatric surgery elicited no additional differences in hepatic or whole-body insulin sensitivity compared to a control diet with comparable calorie intake, suggesting that the reduction of body fat mass is the major contributing factor to the observed metabolic benefits [43].”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [43]
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“Recent interventions with intensive diet and exercise, newer pharmacological agents (e.g., glucagon-like peptide 1 receptor agonists), or surgical weight loss have led to diabetes remission (86 -92)”
From 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024 (2024) · cites this paper as [91]
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Metadata
- Authors
- Yoshino, M., Kayser, B. D., Yoshino, J., Stein, R. I., Reeds, D., Eagon, J. C., Eckhouse, S. R., Watrous, J. D., Jain, M., Knight, R., Schechtman, K., Patterson, B. W., & Klein, S.
- Affiliations
- Washington University in St. Louis (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-08-20
- Volume
- 383
- Issue
- 8
- Pages
- 721-732
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC7456610
- OpenAlex
- W3057164079
- Semantic Scholar
- 58b956f40f349fa8a015a5f60e342e5528184ac1
- Cited by
- 246
- References
- 47
- Citations by year
- 2026: 15 · 2025: 29 · 2024: 28 · 2023: 41 · 2022: 59 · 2021: 57 · 2020: 17
- FWCI
- 39.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32HL130357)
- National Institute of Diabetes and Digestive and Kidney Diseases (K01DK116917, P30DK063491, P30DK56341, R01DK101578, T32DK007296, U24DK097153)
- NIH Office of the Director (S10OD020025)
- National Institute of Environmental Health Sciences (P42ES010337, R01ES027595)
- Pershing Square Foundation
- Foundation for Barnes-Jewish Hospital
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, Roux-en-Y gastric bypass, bariatric surgery, weight loss, dietary therapy, hepatic insulin sensitivity, skeletal muscle insulin sensitivity, beta-cell function, glucose homeostasis, glucose production, insulin-stimulated glucose disposal, obesity, hyperinsulinemic-euglycemic clamp, insulin secretion
- MeSH terms
- Adult, Blood Glucose, Diabetes Mellitus, Type 2, Female, Humans, Insulin, Insulin Resistance, Male, Middle Aged, Obesity, Prospective Studies, Remission Induction, Glucose Clamp Technique, Gastric Bypass, Weight Loss
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