Hepatic and peripheral insulin sensitivity and diabetes remission at 1 month after Roux-en-Y gastric bypass surgery in patients randomized to omentectomy.
Hepatic and peripheral insulin sensitivity and diabetes remission at 1 month after Roux-en-Y gastric bypass surgery in patients randomized to omentectomy.
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DOI：
10.2337/dc11-1383
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发表时间：
2012-01
期刊：
影响因子：
16.2
通讯作者：
Tamboli RA
中科院分区：
文献类型：
--
作者：
Dunn JP;Abumrad NN;Breitman I;Marks-Shulman PA;Flynn CR;Jabbour K;Feurer ID;Tamboli RA
Roux-en-Y胃旁路手术（RYGB）后早期，以胰岛素抵抗为特征的2型糖尿病得到改善。我们确定了RYGB对肝脏和外周胰岛素敏感性的急性影响，无论是否切除网膜。我们还研究了术前糖尿病或术后糖尿病缓解是否影响RYGB后组织特异性胰岛素敏感性。我们研究了40名肥胖（BMI 48±8 kg/m2）的参与者，其中17名患有糖尿病。参与者被随机分为单独RYGB组或联合网膜切除术组。在基线和术后1个月完成高胰岛素-正血糖钳夹与同位素示踪剂输注，以评估胰岛素敏感性。RYGB治疗1个月后，受试者体重减轻（11±4%），外周胰岛素敏感性没有改善；这些结果不受网膜切除术、术前糖尿病或糖尿病缓解的影响。所有受试者的肝葡萄糖生成（HGP）和肝胰岛素敏感性指数均有改善，与网膜切除术无关（P≤0.001）。糖尿病患者基线HGP值较高（P = 0.003）， RYGB治疗后改善程度更大（P = 0.006）。在17名糖尿病患者中，10名（59%）在1个月后缓解。糖尿病缓解对HGP有组×时间效应（P = 0.041）；糖尿病缓解组术前和术后HGP较低。外周胰岛素敏感性在RYGB后1个月没有改善，与网膜切除术、糖尿病或糖尿病缓解无关。肝胰岛素敏感性在RYGB后1个月改善，糖尿病患者更为明显。HGP的改善可能影响RYGB后早期糖尿病的缓解。
Early after Roux-en-Y gastric bypass (RYGB), there is improvement in type 2 diabetes, which is characterized by insulin resistance. We determined the acute effects of RYGB, with and without omentectomy, on hepatic and peripheral insulin sensitivity. We also investigated whether preoperative diabetes or postoperative diabetes remission influenced tissue-specific insulin sensitivity after RYGB. We studied 40 obese (BMI 48 ± 8 kg/m2) participants, 17 with diabetes. Participants were randomized to RYGB alone or in conjunction with omentectomy. Hyperinsulinemic-euglycemic clamps with isotopic-tracer infusion were completed at baseline and at 1 month postoperatively to assess insulin sensitivity. Participants lost 11 ± 4% of body weight at 1 month after RYGB, without an improvement in peripheral insulin sensitivity; these outcomes were not affected by omentectomy, preoperative diabetes, or remission of diabetes. Hepatic glucose production (HGP) and the hepatic insulin sensitivity index improved in all subjects, irrespective of omentectomy (P ≤ 0.001). Participants with diabetes had higher baseline HGP values (P = 0.003) that improved to a greater extent after RYGB (P = 0.006). Of the 17 participants with diabetes, 10 (59%) had remission at 1 month. Diabetes remission had a group × time effect (P = 0.041) on HGP; those with diabetes remission had lower preoperative and postoperative HGP. Peripheral insulin sensitivity did not improve 1 month after RYGB, irrespective of omentectomy, diabetes, or diabetes remission. Hepatic insulin sensitivity improved at 1 month after RYGB and was more pronounced in patients with diabetes. Improvement in HGP may influence diabetes remission early after RYGB.
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影响因子：
5.8
作者：
MITRAKOU, A;VUORINENMARKKOLA, H;GERICH, J
通讯作者：
GERICH, J
仅在发生大量体重减轻并与减肥幅度相关后，才能观察到胃旁路手术后的外周葡萄糖吸收的改善。
影响因子：
3.2
作者：
Campos, Guilherme M.;Rabl, Charlotte;Peeva, Sofia;Ciovica, Ruxandra;Rao, Madhu;Schwarz, Jean-Marc;Havel, Peter;Schambelan, Morris;Mulligan, Kathleen
通讯作者：
Mulligan, Kathleen
影响因子：
29.4
作者：
Fabbrini E;Tamboli RA;Magkos F;Marks-Shulman PA;Eckhauser AW;Richards WO;Klein S;Abumrad NN
通讯作者：
Abumrad NN
影响因子：
5.8
作者：
Nannipieri, M.;Mari, A.;Ferrannini, E.
通讯作者：
Ferrannini, E.
影响因子：
2.9
作者：
Wickremesekera, K;Miller, G;Stubbs, RS
通讯作者：
Stubbs, RS