Comparison of glucostatic parameters after hypocaloric diet or bariatric surgery and equivalent weight loss.
Comparison of glucostatic parameters after hypocaloric diet or bariatric surgery and equivalent weight loss.
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DOI：
10.1038/oby.2011.134
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发表时间：
2011-11
期刊：
影响因子：
--
通讯作者：
Korner J
中科院分区：
文献类型：
--
作者：
Plum L;Ahmed L;Febres G;Bessler M;Inabnet W;Kunreuther E;McMahon DJ;Korner J
非依赖减肥机制可能在Roux-en-Y胃旁路手术(RYGB)后改善血糖稳态中起重要作用。这项分析的目的是确定RYGB在同等体重减轻且不依赖肠内营养通道后，与腹腔镜可调胃束带(LAGB)或低热量饮食(LCD)相比，在降糖参数方面是否有更大的改善。研究1招募了接受LAGB(n=8)或RYGB(n=9)治疗的非2型糖尿病(T2 DM)受试者。研究2招募T2 DM患者，分别接受LCD(n=7)或RYGB(n=7)。在等量减重前后进行胰岛素补充频繁静脉葡萄糖耐量试验(FsIVGTT)。分析胰岛素敏感性(SI)、葡萄糖急性胰岛素反应(AIR G)和C肽反应(ACPRg)，以及胰岛素分泌与胰岛素抵抗程度的关系(处置指数(DI))。所有组的体重下降程度相似(7.8±0.4%)。在研究1中，只有在LAGB治疗后才观察到Si、ACPRg和DI的显著改善。在研究2中，RYGB-DM组的Si、ACPRg和血浆脂联素显著升高，而LCD组则不明显。T2 DM组和T2 DM组的DI均有改善，但治疗后绝对值增加更明显(258.2±86.6vs.55.9±19.9；P<；0.05)。RYGB治疗后，降糖药物停止服用，而LCD治疗后，药物数量减少了55%。没有干预影响空腹高血糖素样多肽(GLP)-1、多肽YY(PYY)或Ghrelin水平。总之，在T2 DM受试者中，与同等体重减轻的饮食相比，RYGB在SI和DI方面有更大的改善。在这个早期时间点，在非糖尿病受试者中没有观察到这样的有益效果。
Weight-loss independent mechanisms may play an important role in the improvement of glucose homeostasis after Roux-en-Y gastric bypass (RYGB). The objective of this analysis was to determine whether RYGB causes greater improvement in glucostatic parameters as compared with laparoscopic adjustable gastric banding (LAGB) or low calorie diet (LCD) after equivalent weight loss and independent of enteral nutrient passage. Study 1 recruited participants without type 2 diabetes mellitus (T2DM) who underwent LAGB (n = 8) or RYGB (n = 9). Study 2 recruited subjects with T2DM who underwent LCD (n = 7) or RYGB (n = 7). Insulin-supplemented frequently-sampled intravenous glucose tolerance test (fsIVGTT) was performed before and after equivalent weight reduction. MINMOD analysis of insulin sensitivity (Si), acute insulin response to glucose (AIRg) and C-peptide (ACPRg) response to glucose, and insulin secretion normalized to the degree of insulin resistance (disposition index (DI)) were analyzed. Weight loss was comparable in all groups (7.8 ± 0.4%). In Study 1, significant improvement of Si, ACPRg, and DI were observed only after LAGB. In Study 2, Si, ACPRg, and plasma adiponectin increased significantly in the RYGB-DM group but not in LCD. DI improved in both T2DM groups, but the absolute increase was greater after RYGB (258.2 ± 86.6 vs. 55.9 ± 19.9; P < 0.05). Antidiabetic medications were discontinued after RYGB contrasting with 55% reduction in the number of medications after LCD. No intervention affected fasting glucagon-like peptide (GLP)-1, peptide YY (PYY) or ghrelin levels. In conclusion, RYGB produced greater improvement in Si and DI compared with diet at equivalent weight loss in T2DM subjects. Such a beneficial effect was not observed in nondiabetic subjects at this early time-point.
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