Acute and long-term effects of Roux-en-Y gastric bypass on glucose metabolism in subjects with Type 2 diabetes and normal glucose tolerance
Abstract
Our aim was to study the potential mechanisms responsible for the improvement in glucose control in Type 2 diabetes (T2D) within days after Roux-en-Y gastric bypass (RYGB). Thirteen obese subjects with T2D and twelve matched subjects with normal glucose tolerance (NGT) were examined during a liquid meal before (Pre), 1 wk, 3 mo, and 1 yr after RYGB. Glucose, insulin, C-peptide, glucagon-like peptide-1 (GLP-1), glucose-dependent-insulinotropic polypeptide (GIP), and glucagon concentrations were measured. Insulin resistance (HOMA-IR), β-cell glucose sensitivity (β-GS), and disposition index (D(β-GS): β-GS × 1/HOMA-IR) were calculated. Within the first week after RYGB, fasting glucose [T2D Pre: 8.8 ± 2.3, 1 wk: 7.0 ± 1.2 (P < 0.001)], and insulin concentrations decreased significantly in both groups. At 129 min, glucose concentrations decreased in T2D [Pre: 11.4 ± 3, 1 wk: 8.2 ± 2 (P = 0.003)] but not in NGT. HOMA-IR decreased by 50% in both groups. β-GS increased in T2D [Pre: 1.03 ± 0.49, 1 wk: 1.70 ± 1.2, (P = 0.012)] but did not change in NGT. The increase in DI(β-GS) was 3-fold in T2D and 1.5-fold in NGT. After RYGB, glucagon secretion was increased in response to the meal. GIP secretion was unchanged, while GLP-1 secretion increased more than 10-fold in both groups. The changes induced by RYGB were sustained or further enhanced 3 mo and 1 yr after surgery. Improvement in glycemic control in T2D after RYGB occurs within days after surgery and is associated with increased insulin sensitivity and improved β-cell function, the latter of which may be explained by dramatic increases in GLP-1 secretion.
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A decrease of 50% in HOMA-IR is seen within 1 week following RYGB.
“A decrease of 50% in HOMA-IR is seen within 1 week following procedures such as RYGB [39].”
From Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects (2020) · cites this paper as [39]
Acute caloric restriction and the immediate dramatic increase in GLP-1 after surgery largely contribute to the improvement in glycemia seen within days.
“the acute caloric restriction and the immediate dramatic increase in the levels of the gut peptide glucagon-like peptide (GLP)-1 after surgery largely contribute to the immense improvement in glycemia seen within days of the procedure [39, 47]”
From Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects (2020) · cites this paper as [39]
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- Authors
- Jørgensen, N. B., Jacobsen, S. H., Dirksen, C., Bojsen-Møller, K. N., Naver, L., Hvolris, L., Clausen, T. R., Wulff, B. S., Worm, D., Lindqvist Hansen, D., Madsbad, S., & Holst, J. J.
- Affiliations
- University of Copenhagen (DK)
- Hvidovre Hospital (DK)
- Novo Nordisk (Denmark) (DK)
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark;
- Corresponding author
- Jørgensen, N. B.
- ORCID
- Venue
- American Journal of Physiology-Endocrinology and Metabolism
- Publisher
- American Physiological Society
- Published
- 2012-07-01
- Volume
- 303
- Issue
- 1
- Pages
- E122-E131
- ISSN
- 0193-1849 (ISSN-L)
- 1522-1555
- OpenAlex
- W2129549955
- Cited by
- 313
- References
- 49
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 11 · 2023: 15 · 2022: 20 · 2021: 27 · 2020: 17 · 2019: 36 · 2018: 22 · 2017: 30 · 2016: 28 · 2015: 32 · 2014: 16 · 2013: 34 · 2012: 4
- FWCI
- 28.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Physiology-Endocrinology and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- Roux-en-Y gastric bypass, type 2 diabetes, glucose metabolism, insulin resistance, beta-cell function, glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, glucagon, C-peptide, insulin secretion, bariatric surgery, obesity, glycemic control, insulin sensitivity
- MeSH terms
- Adult, C-Peptide, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glucagon, Glucose, Humans, Hyperglycemia, Insulin Resistance, Male, Middle Aged, Obesity, Obesity, Morbid, Time Factors, Gastric Bypass, Body Mass Index, Postprandial Period, Insulin-Secreting Cells, Glucagon-Like Peptide 1
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