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Effect of Weight Loss by Gastric Bypass Surgery Versus Hypocaloric Diet on Glucose and Incretin Levels in Patients with Type 2 Diabetes
Open accessAbstract
CONTEXT: Gastric bypass surgery (GBP) results in rapid weight loss, improvement of type 2 diabetes (T2DM), and increase in incretins levels. Diet-induced weight loss also improves T2DM and may increase incretin levels. OBJECTIVE: Our objective was to determine whether the magnitude of the change of the incretin levels and effect is greater after GBP compared with a low caloric diet, after equivalent weight loss. DESIGN AND METHODS: Obese women with T2DM studied before and 1 month after GBP (n = 9), or after a diet-induced equivalent weight loss (n = 10), were included in the study. Patients from both groups were matched for age, body weight, body mass index, diabetes duration and control, and amount of weight loss. SETTING: This outpatient study was conducted at the General Clinical Research Center. MAIN OUTCOME MEASURES: Glucose, insulin, proinsulin, glucagon, gastric inhibitory peptide (GIP), and glucagon-like peptide (GLP)-1 levels were measured after 50-g oral glucose. The incretin effect was measured as the difference in insulin levels in response to oral and to an isoglycemic iv glucose load. RESULTS: At baseline, none of the outcome variables (fasting and stimulated values) were different between the GBP and diet groups. Total GLP-1 levels after oral glucose markedly increased six times (peak:17 +/- 6 to 112 +/- 54 pmol/liter; P < 0.001), and the incretin effect increased five times (9.4 +/- 27.5 to 44.8 +/- 12.7%; P < 0.001) after GBP, but not after diet. Postprandial glucose levels (P = 0.001) decreased more after GBP. CONCLUSIONS: These data suggest that early after GBP, the greater GLP-1 and GIP release and improvement of incretin effect are related not to weight loss but rather to the surgical procedure. This could be responsible for better diabetes outcome after GBP.
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“Previous studies have established that the incretin effect, β-cell secretion activated by eating, is increased in GB patients with type 2 diabetes (6,9).”
From Gastric Bypass Surgery Enhances Glucagon-Like Peptide 1–Stimulated Postprandial Insulin Secretion in Humans (2011) · cites this paper as [9]
In the citing paper
“Previous studies have reported that glucagon secretion after GB is elevated after meal ingestion (9,16,25)”
From Gastric Bypass Surgery Enhances Glucagon-Like Peptide 1–Stimulated Postprandial Insulin Secretion in Humans (2011) · cites this paper as [9]
In the citing paper
“GB subjects have elevated plasma concentrations of GLP-1 (6,8–13).”
From Gastric Bypass Surgery Enhances Glucagon-Like Peptide 1–Stimulated Postprandial Insulin Secretion in Humans (2011) · cites this paper as [9]
In the citing paper
“These findings suggest that the relatively higher postprandial insulin responses seen in patients after GB (8,9,12,23) are not a response to insulin resistance or the result of general hypersensitivity of β-cells to glucose.”
From Gastric Bypass Surgery Enhances Glucagon-Like Peptide 1–Stimulated Postprandial Insulin Secretion in Humans (2011) · cites this paper as [9]
In the citing paper
“this obesity-independent hypoglycemic effect has been related to the action of GLP-1 in promoting insulin section [3], [6].”
From Treatment of obesity and diabetes using oxytocin or analogs in patients and mouse models (2013) · cites this paper as [6]
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“Glucagon-like peptide 1 (GLP-1) is a hormone produced in the intestinal epithelial endocrine L-cells that increases after gastric bypass surgery but not after diet-induced weight loss (28).”
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BackgroundFrom Entero-Endocrine Cell Biology to Surgical Interventional Therapies for Type 2 Diabetes
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“Clinical studies have identified increased incretin levels in the early weight-independent and diet-independent effects of RYGB (15, 16), and reduced incretin levels after RYGB may play a role in weight regain and diabetes relapse (31).”
BackgroundKoffert, J., Lahti, L., Nylund, L., Salminen, S., Hannukainen, J. C., Salminen, P. T. P., de Vos, W. M., & Nuutila, P. (2020) · PeerJ · doi:10.7717/peerj.10442 · Cited by 8
“However, reduced food ingestion, increased satiety, increased gastric emptying and shift in bile acid metabolism have been suggested to have a role (Laferrere et al., 2008; Plum et al., 2011).”
BackgroundChirurgie als pluripotentes Instrument gegen eine metabolische Erkrankung
Corteville, C., Faßnacht, M., & Bueter, M. (2014) · Zurich Open Repository and Archive (University of Zurich) · doi:10.5167/uzh-171966 · Cited by 7
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“After operations that result in rapid entry of nutrients into the lower ileum (JI bypass, gastric bypass, and duodenal switch), resolution of T2D occurs in about 80% of patients [24,25].”
BackgroundTreating type 2 diabetes: incretin mimetics and enhancers
Janosz, K. E. N., Zalesin, K. C., Miller, W. M., & McCullough, P. A. (2009) · Therapeutic Advances in Cardiovascular Disease · doi:10.1177/1753944709341377 · Cited by 7
“In a recent study by Laferrere et al. the Roux-en-Y gastric bypass procedure was noted to augment incretin release [Laferrere et al. 2008].”
Surgical Approaches for the Prevention and Treatment of Type 2 Diabetes Mellitus
Coffin, S. T., Konduru, C., Schwarcz, M., & Frishman, W. H. (2009) · Cardiology in Review · doi:10.1097/crd.0b013e3181bc23d1 · Cited by 7
“Lower levels of gherlin (increase appetite) and increased postprandial peptide YY may also occur to enhance diabetes control.(48,49) Two principal theories explain the possible mechanism of resolution of diabetes after bariatric procedure: the foregut and hindgut theory.”
BackgroundCOHEN, R. V., Petry, T. B. Z., & Caravatto, P. P. D. P. (2013) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2013.08.004 · Cited by 7
“[19] Laferrère B, Teixeira J, McGinty J, et al.”
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“An interesting finding in this and other studies is that both the RYGB and the obese control groups had higher fasting levels of glucagon than the nonobese controls; however, unique to the RYGB group was a sustained postprandial elevation of glucagon levels that was greater than in BMI-matched controls [25, 27, 28, 36…”
ResultProposed treatment strategy for reactive hypoglycaemia
Younes, Y. R., Cron, N., Field, B. C. T., Nayyar, V., Clark, J., Zachariah, S., Lakshmipathy, K., Isuga, J., Maghsoodi, N., & Emmanuel, J. J. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1332702 · Cited by 6
“The condition is believed to result from accelerated gastric emptying causing hyperglycaemic peaks and excessive release of the incretin hormones, GLP-1 and GIP, resulting in hyperinsulinemia (4, 5).”
BackgroundDolo, P. R., Li, C., Zhu, X., Yao, L., Song, M., & Hong, J. (2018) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2018.07.009 · Cited by 6
Physiology Reconfigured: How Does Bariatric Surgery Lead to Diabetes Remission?
Albaugh, V. L., Axelrod, C. L., Belmont, K. P., & Kirwan, J. P. (2022) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2022.06.003 · Cited by 7
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Xuan, C., Huang, Z., Ran, W., Liao, G., Zha, L., & Wang, Z. (2014) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2014.1832 · Cited by 6
“GBP may primarily contribute to the reduction of blood glucose levels in patients with T2DM rather than the control of weight (22-24).”
Vella, A. V. (2013) · Diabetes · doi:10.2337/db13-0806 · Cited by 6
“In an intact upper gastrointestinal tract, GLP-1 also delays gastric emptying (5) and increases gastric accommodation (6).”
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ESTADO NUTRICIONAL E AS COMORBIDADES ASSOCIADAS AO DIABETES MELLITUS TIPO 2 NO IDOSO
Tatsch, C. G., Fischer, M. D. Q., & Poll, F. A. (2016) · Estudos Interdisciplinares sobre o Envelhecimento · doi:10.22456/2316-2171.59049 · Cited by 6
Patel, K., Levesque, K., Mark, V., Pierini, E., Rojas, B., Ahlers, M. J., Shah, A. M., & Laferrère, B. (2019) · Journal of Diabetes · doi:10.1111/1753-0407.12964 · Cited by 6
“However, GLP-1 may be only one of many mediators of glucose control after RYGB, because the infusion of the GLP-1 receptor inhibitor exendin (9-39) worsens postprandial glucose only minimally after RYGB.”
BackgroundObesity and the need for bariatric surgery in P akistan
Shah, A. A., & Shariff, A. H. (2013) · Asian Journal of Endoscopic Surgery · doi:10.1111/ases.12048 · Cited by 6
β-Cell Function After Weight-Loss Induced by Bariatric Surgery
Vella, A. V. (2014) · Physiology · doi:10.1152/physiol.00003.2014 · Cited by 6
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Going With the Flow: Adaptation of β-Cell Function to Glucose Fluxes After Bariatric Surgery
Salehi, M., & D’Alessio, D. A. (2013) · Diabetes · doi:10.2337/db13-1213 · Cited by 5
Ligon, C., Shah, A. M., PRASAD, M. A., & Laferrère, B. (2021) · Diabetes Care · doi:10.2337/dc21-0395 · Cited by 5
¿Es la diabetes mellitus tipo 2 una enfermedad de tratamiento quirurgico?
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The role of obestatin in roux‐en‐Y gastric bypass‐induced remission of type 2 diabetes mellitus
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“not only significantly reduced plasma glucose levels after 50 g oral glucose tolerance test (OGTT) but also decreased OGTT-induced plasma glucose excursions as compared with subjects in the diet group [25].”
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Post-Gastric Bypass Hypoglycemia: Diagnosis and Management
Fischer, L. E., Davis, D. B., Khoraki, J., & Campos, G. M. (2016) · Springer eBooks · doi:10.1007/978-3-319-27114-9_21 · Cited by 4
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Surgical Treatment of Morbid Obesity
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“(incretin)으로 생각되어 이에 대한 연구가 활발히 진행되어 오 고 있다.(55,56) 이와 같이, 장 호르몬이 혈당조절에 관여한다는 것”
A Gut Check Explains Improved Glucose Metabolism after Surgery
Laferrère, B., & Pattou, F. N. (2019) · Cell Metabolism · doi:10.1016/j.cmet.2019.10.002 · Cited by 4
Hauner, H., Wirth, A. G., Gola, U., Teufel, M., Zipfel, S., de Zwaan, M., Hüttl, T. P., Kramer, K. M., & Winckler, K. (2013) · Springer eBooks · doi:10.1007/978-3-642-22855-1_7 · Cited by 4
Tuero, C., Rodrı́guez, A., Ramírez, B., Catalán, V., Cienfuegos, J. A., Gómez‐Ambrosi, J., Valentí, V., Moncada, R., Frühbeck, G., & Becerril, S. (2025) · The Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2025.110124 · Cited by 3
Metadata
- Authors
- Laferrère, B., Teixeira, J., McGinty, J., Tran, H., Egger, J. R., Colarusso, A., Kovack, B., Bawa, B., Koshy, N., Lee, H., Yapp, K., & Olivan, B.
- Affiliations
- Obesity Research Center (B.L., H.T., J.R.E., A.C., B.K., B.B., K.Y., B.O.), St. Luke’s/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025
- Bariatric Division (J.T., J.M., N.K., H.L.), St. Luke’s/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025
- St. Luke's-Roosevelt Hospital Center (US)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2008-07-01
- Volume
- 93
- Issue
- 7
- Pages
- 2479-2485
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC2453054
- OpenAlex
- W2146737709
- Cited by
- 682
- References
- 57
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 11 · 2023: 18 · 2022: 17 · 2021: 25 · 2020: 25 · 2019: 39 · 2018: 21 · 2017: 45 · 2016: 48 · 2015: 44 · 2014: 57 · 2013: 72 · 2012: 59
- FWCI
- 63.22
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK 67561, DK63068-05, DK 26687, R01DK067561, P30DK026687)
- National Center for Research Resources (UL1RR024156)
- 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
- gastric bypass, type 2 diabetes, weight loss, incretin effect, glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, proinsulin, glucagon, insulin, postprandial blood glucose, hypocaloric diet, obesity, women
- MeSH terms
- Adult, Blood Glucose, Diabetes Mellitus, Type 2, Diet, Reducing, Female, Gastric Inhibitory Polypeptide, Glucagon, Humans, Male, Middle Aged, Obesity, Gastric Bypass, Weight Loss, Glucagon-Like Peptide 1, Incretins
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