Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes.
Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes.
复制标题
DOI：
10.1038/ijo.2009.254
复制
发表时间：
2010-03
影响因子：
4.9
通讯作者：
Schauer, P. R.
中科院分区：
文献类型：
--
作者：
Kashyap, S. R.;Daud, S.;Kelly, K. R.;Gastaldelli, A.;Win, H.;Brethauer, S.;Kirwan, J. P.;Schauer, P. R.
关键词：
高血压在减肥手术后迅速消退，但潜在的机制和最有效的手术类型仍不清楚。检测2型糖尿病（T2 DM）患者在接受两种减肥干预（Roux-en-Y胃旁路术（RYGB）和胃限制性（GR）手术）后的糖代谢和β细胞功能。前瞻性、非随机、重复测量、4周、纵向临床试验。共有16例T2 DM患者（9例男性和7例女性，52±14岁，47±9 kg m−2，HbA 1c 7.2±1.1%）接受RYGB（N=9）或GR（N=7）手术。使用高血糖钳夹和C肽建模动力学，在基线和术后1周和4周时的葡萄糖、胰岛素分泌、胰岛素敏感性;在基线和术后4周时的葡萄糖、胰岛素分泌和肠肽对混合餐耐量试验（MMTT）的反应。术后1周，两组体重减轻和空腹血糖下降相似（P<0.01）。而胰岛素敏感性仅在RYGB后增加（P<0.05）。在术后4周，两组的体重减轻保持相似，但空腹血糖仅在RYGB后恢复正常（95±3 mg 100 ml−1）。胰岛素敏感性在RYGB后明显改善（P<0.01），而不随GR改变，而处置指数在RYGB后保持不变，GR后增加30%（P=0.10）。MMTT仅在RYGB后引起胰岛素分泌、胰高血糖素样肽-1（GLP-1）水平和β细胞对葡萄糖的敏感性显著增加（P<0.05）。与GR相比，RYGB在葡萄糖调节方面提供了更快的改善。这种改善伴随着胰岛素敏感性和β细胞对葡萄糖的反应性增强，部分原因是肠促胰岛素效应。
Hyperglycemia resolves quickly after bariatric surgery, but the underlying mechanism and the most effective type of surgery remains unclear. To examine glucose metabolism and β-cell function in patients with type 2 diabetes mellitus (T2DM) after two types of bariatric intervention; Roux-en-Y gastric bypass (RYGB) and gastric restrictive (GR) surgery. Prospective, nonrandomized, repeated-measures, 4-week, longitudinal clinical trial. In all, 16 T2DM patients (9 males and 7 females, 52±14 years, 47±9 kg m−2, HbA1c 7.2±1.1%) undergoing either RYGB (N=9) or GR (N=7) surgery. Glucose, insulin secretion, insulin sensitivity at baseline, and 1 and 4 weeks post-surgery, using hyperglycemic clamps and C-peptide modeling kinetics; glucose, insulin secretion and gut-peptide responses to mixed meal tolerance test (MMTT) at baseline and 4 weeks post-surgery. At 1 week post-surgery, both groups experienced a similar weight loss and reduction in fasting glucose (P<0.01). However, insulin sensitivity increased only after RYGB, (P<0.05). At 4 weeks post-surgery, weight loss remained similar for both groups, but fasting glucose was normalized only after RYGB (95±3 mg 100 ml−1). Insulin sensitivity improved after RYGB (P<0.01) and did not change with GR, whereas the disposition index remained unchanged after RYGB and increased 30% after GR (P=0.10). The MMTT elicited a robust increase in insulin secretion, glucagon-like peptide-1 (GLP-1) levels and β-cell sensitivity to glucose only after RYGB (P<0.05). RYGB provides a more rapid improvement in glucose regulation compared with GR. This improvement is accompanied by enhanced insulin sensitivity and β-cell responsiveness to glucose, in part because of an incretin effect.
登录
查看更多内容
影响因子：
2.9
作者：
O'Brien, PE;Dixon, JB;Anderson, M
通讯作者：
Anderson, M
影响因子：
16.2
作者：
Laferrere, Blandine;Heshka, Stanley;Olivan, Blanca
通讯作者：
Olivan, Blanca
影响因子：
2.9
作者：
Roa, Paul E.;Kaidar-Person, Orit;Rosenthal, Raul J.
通讯作者：
Rosenthal, Raul J.
影响因子：
7.7
作者：
POLONSKY, KS;GUMBINER, B;HENRY, RR
通讯作者：
HENRY, RR
影响因子：
4.9
作者：
Korner, J.;Inabet, W.;Fabres, G.;Conwell, I. M.;McMahon, D. J.;Salas, R.;Taveras, C.;Schrope, B.;Bessler, M.
通讯作者：
Bessler, M.