Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes
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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DOI：
10.2337/dc06-1549
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发表时间：
2007-07-01
期刊：
影响因子：
16.2
通讯作者：
Olivan, Blanca
中科院分区：
文献类型：
--
作者：
Laferrere, Blandine;Heshka, Stanley;Olivan, Blanca
目的 - 关于接受 Roux-en-Y 胃绕道手术 (RY-GBP) 的患者的有限数据表明，手术后胰岛素分泌迅速改善，因此可能不能完全归因于体重减轻。我们假设，在患有 2 型糖尿病的肥胖患者中，RY-GBP 会导致肠促胰岛素水平受损和作用发生变化。 研究设计和方法 - 在 RY-GBP 之前和之后 1 个月，测量了 8 名患有 2 型糖尿病的肥胖女性和 7 名肥胖女性的肠促胰岛素（胃抑制剂、肽 [GIP] 和胰高血糖素样肽 1 [GLP-1]）水平及其对胰岛素分泌的影响。 肥胖的非糖尿病对照受试者。肠降血糖效果通过口服葡萄糖耐量试验 (OGTT) 和等血糖静脉葡萄糖试验的胰岛素分泌差异（曲线下面积 [AUC]）来测量。 结果 - 对照受试者与手术前 2 型糖尿病患者之间，Fastin 以及 GLP-1 和 GIP 的刺激水平没有差异。 RY-GBP后1个月，体重下降9.2 +/- 7.0 kg，口服葡萄糖刺激的GLP-1 (AUC)和GIP峰值水平显着增加24.3 +/- 7.9 pmol。分别为 1(-1).min(-1) (P < 0.0001) 和 131 +/- 85 pg/ml (P = 0.007)。 RY-GBP 后，减弱的肠促胰素效应从 7.6 +/- 28.7 显着增加至 42.5 +/- 11.3 (P= 0.005)，此时与对照受试者的时间没有差异 (53.6 +/- 23.5%，P = 0.284)。 结论 - 这些数据表明，RY-GBP 后早期，GLP-1 和 GLP-1 升高。 GIP 释放可能是改善胰岛素的潜在介质 分泌。
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 consequence of RY-GBP.RESEARCH DESIGN AND METHODS - Incretin (gastric inhibitor, peptide [GIP] and glucagon-like peptide-1 [GLP-1]) levels and their effect on insulin secretion were measured before and I 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- Fastin 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 . 1(-1).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 fromthat 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.