Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes
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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 x l(-1) x 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.
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Gastric bypass subjects have elevated plasma concentrations of GLP-1.
“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 [6]
The incretin effect is increased in gastric bypass patients with type 2 diabetes.
“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 [6]
The insulin response to meal ingestion is exaggerated after gastric bypass surgery.
“it is clear that the insulin response to meal ingestion is exaggerated after surgery (6).”
From Gastric Bypass Surgery Enhances Glucagon-Like Peptide 1–Stimulated Postprandial Insulin Secretion in Humans (2011) · cites this paper as [6]
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Ejarque, M., Guerrero-Pérez, F., de la Morena, N., Casajoana, A., Virgili, N., López-Urdiales, R., Maymó-Masip, E., Pujol Gebelli, J., Garcia Ruiz de Gordejuela, A., Perez-Maraver, M., et al. (2019) · Scientific Reports · doi:10.1038/s41598-019-42770-1 · Cited by 53 · see citing works
Diabetes after Bariatric Surgery
Shah, A., & Laferrère, B. (2017) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2016.12.009 · Cited by 50 · see citing works
Rhee, N. A., Vilsbøll, T., & Knop, F. K. (2012) · Diabetes, Obesity and Metabolism · doi:10.1111/j.1463-1326.2011.01505.x · Cited by 47 · see citing works
Rothkopf, M. M., Bilof, M. L., Haverstick, L. P., & Nusbaum, M. J. (2009) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2008.09.005 · Cited by 15 · see citing works
Assessment of the incretin effect in healthy subjects: concordance between clamp and OGTT methods
Aulinger, B. A., & D’Alessio, D. A. (2023) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00104.2022 · Cited by 6 · see citing works
- Authors
- Laferrère, B., Heshka, S., Wang, K., Khan, Y., McGinty, J., Teixeira, J., Hart, A. B., & Olivan, B.
- Affiliations
- Obesity Research Center, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York
- St. Luke's-Roosevelt Hospital Center (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2007-07-01
- Volume
- 30
- Issue
- 7
- Pages
- 1709-1716
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2743330
- OpenAlex
- W2166561625
- Cited by
- 532
- References
- 61
- Citations by year
- 2026: 11 · 2025: 9 · 2024: 10 · 2023: 16 · 2022: 19 · 2021: 29 · 2020: 22 · 2019: 27 · 2018: 20 · 2017: 27 · 2016: 29 · 2015: 35 · 2014: 47 · 2013: 35 · 2012: 43
- FWCI
- 32.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Diabetes Association
- National Institutes of Health (RR-00645)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK63068-05, DK 26687, R01DK067561, P30DK026687, P30DK063608)
- National Center for Research Resources (RR 00645, M01RR000645)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- Roux-en-Y gastric bypass, bariatric surgery, type 2 diabetes, obesity, incretins, glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, insulin secretion, incretin effect, weight loss, oral glucose tolerance test
- MeSH terms
- Adult, Diabetes Mellitus, Type 2, Female, Gastric Inhibitory Polypeptide, Humans, Insulin, Middle Aged, Obesity, Laparoscopy, Postoperative Period, Gastric Bypass, Glucagon-Like Peptide 1
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