Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes
Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes
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DOI：
10.1210/jc.2007-2851
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发表时间：
2008-07-01
影响因子：
5.8
通讯作者：
Olivan, Blanca
中科院分区：
文献类型：
--
作者：
Laferrere, Blandine;Teixeira, Julio;Olivan, Blanca
背景：胃旁路手术（GBP）导致体重迅速减轻，2型糖尿病（T2 DM）改善，肠促胰岛素水平升高。饮食诱导的体重减轻也改善了2型糖尿病，并可能增加肠促胰岛素水平。目的：我们的目的是确定在同等体重减轻后，与低热量饮食相比，GBP后肠促胰岛素水平和效果的变化幅度是否更大。设计和方法：研究纳入了在GBP之前和之后1个月（n = 9）或饮食诱导的等效体重减轻之后（n = 10）研究的肥胖T2 DM女性。两组患者的年龄、体重、体重指数、糖尿病病程和控制情况以及体重减轻情况相匹配。设置：这项门诊研究在综合临床研究中心进行。主要结果测量：50 g口服葡萄糖后测量葡萄糖、胰岛素、胰岛素原、胰高血糖素、胃抑制肽（GIP）和胰高血糖素样肽（GLP）-1水平。肠促胰岛素的影响被测量为响应于口服和isoglycosidine iv葡萄糖load.Results的胰岛素水平的差异：在基线时，没有结果变量（空腹和刺激值）之间的GBP和饮食组不同。口服葡萄糖后总GLP-1水平显著增加了6倍（峰值：17 +/- 6至112 +/- 54 pmol/L; P < 0.001），GBP后肠促胰岛素效应增加了5倍（9.4 +/- 27.5至44.8 +/- 12.7%; P < 0.001），但饮食后没有。餐后血糖水平（P = 0.001）下降后GBP。结论：这些数据表明，早期GBP后，更大的GLP-1和GIP的释放和肠促胰岛素的效果改善相关的体重减轻，而是手术。这可能是GBP后糖尿病结局更好的原因。
Context: Gastric bypass surgery (GBP) results in rapid weight loss, improvement of type 2 diabetes (T2DM), and increase in incretins levels. Diet-induced weight loss also improves T2DM and may increase incretin levels.Objective: Our objective was to determine whether the magnitude of the change of the incretin levels and effect is greater after GBP compared with a low caloric diet, after equivalent weight loss.Design and Methods: Obese women with T2DM studied before and 1 month after GBP (n = 9), or after a diet-induced equivalent weight loss (n = 10), were included in the study. Patients from both groups were matched for age, body weight, body mass index, diabetes duration and control, and amount of weight loss.Setting: This outpatient study was conducted at the General Clinical Research Center.Main Outcome Measures: Glucose, insulin, proinsulin, glucagon, gastric inhibitory peptide (GIP), and glucagon-like peptide (GLP)-1 levels were measured after 50-g oral glucose. The incretin effect was measured as the difference in insulin levels in response to oral and to an isoglycemic iv glucose load.Results: At baseline, none of the outcome variables (fasting and stimulated values) were different between the GBP and diet groups. Total GLP-1 levels after oral glucose markedly increased six times (peak: 17 +/- 6 to 112 +/- 54 pmol/liter; P < 0.001), and the incretin effect increased five times (9.4 +/- 27.5 to 44.8 +/- 12.7%; P < 0.001) after GBP, but not after diet. Postprandial glucose levels (P = 0.001) decreased more after GBP.Conclusions: These data suggest that early after GBP, the greater GLP-1 and GIP release and improvement of incretin effect are related not to weight loss but rather to the surgical procedure. This could be responsible for better diabetes outcome after GBP.