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Postprandial Diabetic Glucose Tolerance Is Normalized by Gastric Bypass Feeding as Opposed to Gastric Feeding

Obesity increases the likelihood of diseases like type 2 diabetes (T2D), heart disease, and cancer, and is one of the most serious public health problems of this century. The 126 consecutive patients treated by LRYGB between January 1, 2001 and December 31, 2002 were analyzed in August 2011. There are clear differences between weight loss by GBP and by dietary intervention or gastric banding. Fasting glucose was lower after RYGB than after LS/IMM, although the glucose area under the curve decreased comparably for both groups. type 2 diabetes and other metabolic diseases,” lead author Dr. Mean length of follow-up after surgery was 2.88 years. In non-diabetics, compared to preoperative levels, there were significant increases in GLP-1 and desacyl-ghrelin in the nondiabetic patients (P = 0.046 and P = 0.016, respectively); no change in plasma insulin, active ghrelin, NPY, or GIP was demonstrated.

The scientists said the results demonstrate that the extremely restrictive diet imposed after bariatric surgery is responsible for the rapid diabetes remission, which occurs within days of the procedure normally. The risk of developing type 2 diabetes mellitus (T2D) increases linearly with body mass index (BMI).1,2 Accordingly, the increase in the prevalence of obesity is likely responsible for the recent increase in T2D,3,4 which has become a major global health problem because of its high prevalence, causal relationship with serious medical complications and economic impact. Type 2 diabetes arises from a relative insulin deficiency for the prevailing defect in insulin action, and present understanding suggests that, for a given degree of glucose tolerance, there is a hyperbolic relationship between insulin secretion and action such that for a small decrease in insulin action there is a compensatory increase in insulin secretion (6). “Providers and patients need to be aware of this information to have a better idea of the expected outcome and to be able to make an informed decision about pursuing gastric bypass surgery,” says Ramos. Over a period of 1 yr after surgery, diabetes remission depends on the starting degree of β-cell dysfunction. Listen to your body and your surgeon. These levels vary with the amount of protein from food and the processing of amino acids by the liver and muscle.

The percentage of procedures requiring reoperations due to complications was 15.3 percent for the gastric band, 7.7 percent for gastric bypass and 1.5 percent for sleeve gastrectomy. We examined the patient 5 weeks postoperatively, at which time the patient was fed perorally but still had the gastric tube. The patient had lost 14 kg (BMI 45.2 kg/m2). Informed consent was obtained prior to examination. On 2 consecutive days at 8.30 a.m. Patients of this surgery type had a 47 percent increased risk of bone fracture. As part of clinical management we will ensure that all patients with diabetes will have a kidney (2 samples of morning urine albumin creatinine ratio), nerve (nerve conduction study, including thermal threshold testing) and eye (retinal photograph) tests once before and within 1, 2 and 3 years after surgery.

105: Bariatric surgery and pregnancy. It involves the creation of a small gastric pouch which is drained into the jejunum (alimentary limb) with no contact between nutrients and the pylorus and duodenum. Figure includes iAUC estimations. Type 2 diabetes is far more common than type I diabetes, and an increasing number of people are getting it in their teens. Early consultation with a bariatric surgeon is critical to determine whether the symptoms are related to the surgery. Plasma insulin, C-peptide, glucagon, and incretin hormone were quantified as earlier described (3). Incremental area under the curve (iAUC) was calculated using the trapezoidal model.

Currently the National Institutes of Health guidelines recommend weight loss surgery for patients with a body mass index (BMI) over 40. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated as (insulinfasting × Glufasting)/22.5. Plasma concentrations and iAUC for glucose, insulin, C-peptide, glucagon, total glucagon-like peptide-1 (GLP-1), intact glucose-dependent insulinotropic polypeptide (GIP), PYY, and FFAs after peroral and gastroduodenal feeding are shown in Fig. 1. Plasma glucose concentration peaked earlier and returned more rapidly to fasting values after peroral than gastroduodenal feeding, as illustrated by a markedly reduced 2-h plasma glucose concentration (7.8 vs. 11.1 mmol/l). iAUCGlu was noticeably lower after peroral feeding.

The peak values of plasma insulin and C-peptide were higher after peroral than gastroduodenal feeding (fourfold and twofold, respectively) and iAUCinsulin and iAUCCpeptide were also clearly elevated. IGI was improved after peroral feeding (115 vs. 72 pmol/mmol), and the iAUCCpeptide/Glu ratio was more than twofold increased (0.90 vs. 0.40 nmol/mmol). HOMA-IR remained unchanged on the 2 examination days (3.3 vs. Therefore it may be argued that improved glycaemic control occurs before significant weight loss. GLP-1 plasma concentration peaked simultaneously after peroral and gastroduodenal feeding, but the peak value was more than threefold increased (87 vs.

28 pmol/l), and iAUCGLP-1 was nearly fivefold increased after peroral feeding. Insulin and GLP-1 correlated strongly after peroral (r = 0.92, P < 0.001) but not gastroduodenal (r = 0.55, P = 0.08) feeding. Plasma concentrations of glucagon and intact GIP were similar on both days. Responses of PYY and FFAs are depicted in the figure. And on such a meager diet, the weight began to disappear. Here, we report important differences in β-cell function and glucose metabolism after peroral compared with gastroduodenal feeding in a patient with RYGB and a gastrostomy, where differences in insulin sensitivity, weight loss, and caloric restriction can be ruled out as explanations for the improved glucose tolerance. Our results show marked improvement in glucose tolerance with near normalization of 2-h postprandial plasma glucose value and a 33% reduction in iAUCGlu after peroral feeding compared with gastroduodenal feeding. In contrast, during gastroduodenal feeding glucose tolerance was diabetic with a 2-h postprandial plasma glucose value ∼11 mmol/l. The improvement was accompanied by a twofold increase in β-cell secretory response (AUCCpeptide/Glu), which was associated with a fivefold increase in iAUCGLP-1. Insulin and GLP-1 concentrations during peroral feeding were strongly correlated, which is suggestive of a causal relationship. Interestingly, the insulin and C-peptide response curves found after gastroduodenal feeding resemble the responses found in type 2 diabetic patients, whereas the response curves after peroral feeding are similar to those found in healthy control subjects (4). The emptying time is likely to be slower after feeding into the bypassed gastric remnant, which could explain the slower peak in plasma glucose observed after gastroduodenal feeding but would also, per se, be expected to result in decreased postprandial glucose excursions. The observed improvements in glucose tolerance and GLP-1 secretion are in concordance with earlier findings from patients examined before and after RYGB surgery (5–13). Regarding GIP, some studies have demonstrated increased (7,10) and others decreased (9,13) responses after RYGB. In our patient, GIP responses were similar on the 2 days, suggesting that changes in GIP were not responsible for the differences in insulin secretion and glucose tolerance. Also glucagon responses were similar. In conclusion, our results suggest that RYGB has a direct beneficial effect on postprandial glucose metabolism, most likely due to an increased insulin secretion caused by the massive increase in GLP-1 that is probably due to the rapid exposure of l-cells in the distal small intestine to nutrients (14). It has been suggested that duodenal exclusion inherent in the RYGB somehow might be responsible for the improvement in glucose tolerance (15). In this respect, it is of interest that the secretion of the upper jejunal hormone, GIP, was similar during peroral or gastroduodenal feeding. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Complications are often reported under a separate medical billing code. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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