Loss insulin resistance after roux-en-Y gastric bypass surgery: a time course study
Loss insulin resistance after roux-en-Y gastric bypass surgery: a time course study
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DOI：
10.1381/0960892053723402
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发表时间：
2005-04-01
期刊：
影响因子：
2.9
通讯作者：
Stubbs, RS
中科院分区：
文献类型：
--
作者：
Wickremesekera, K;Miller, G;Stubbs, RS
背景：胃旁路手术已多次被证明可以通过显著改善胰岛素抵抗来改善甚至治愈2型糖尿病。其实现这一点的机制目前尚不清楚，但有些人假设胃、十二指肠或近端空肠的旁路可能带来重要的体液效应。更好地了解手术后胰岛素抵抗的变化的时间过程可能有助于我们了解潜在的mechanism.Methods：静脉葡萄糖耐量试验（IVGTT）在26例严重肥胖患者胃旁路手术的早晨和6天后再次进行。此外，在71例接受胃旁路手术的患者中，在手术前通过稳态模型评估（HOMA）方法评估胰岛素抵抗，并在6天、3、6、9和12个月再次评估胰岛素抵抗。结果：3组患者术前均存在胰岛素抵抗，术前胰岛素抵抗程度与糖耐量正常组比较差异有统计学意义（P < 0. 05）。如HOMA所示，这在糖尿病患者中最大。在所有组中，通过IVGTT和HOMA方法，胃旁路术后6天内胰岛素抵抗均显著减轻/改善，并维持了12个月。这项研究包括31名糖尿病患者，其中只有3名需要药物治疗后出院。结论：胰岛素抵抗的变化，胃旁路手术后，这是负责的决议或改善2型糖尿病发生在6天内的手术，之前任何明显的体重减轻已经发生。这一发现对我们理解严重肥胖患者的胰岛素抵抗机制具有重要意义，并且与源自胃肠道的体液机制一致。
Background: Gastric bypass has repeatedly been shown to improve and even cure type 2 diabetes by substantially improving insulin resistance. The mechanism by which it achieves this is not currently known, but some have hypothesized that there may be important humoral effects brought about by the bypass of the stomach, duodenum or proximal jejunum. A better understanding of the time course of the changes in insulin resistance after surgery might assist our understanding of potential mechanisms.Methods: Intravenous glucose tolerance tests (IVGTT) were performed in 26 severely obese patients on the morning of gastric bypass surgery and again 6 days later. In addition insulin resistance was assessed in 71 patients undergoing gastric bypass surgery by the homeostasis model assessment (HOMA) method before surgery, and again at 6 days, 3, 6, 9, and 12 months. Patients were divided into 3 groups for analysis: diabetics, impaired glucose tolerance and normal glucose tolerance.Results: All 3 groups of patients were noted to have insulin resistance prior to surgery. This was greatest in the diabetic patients, as indicated by HOMA. There was marked loss of/improvement in insulin resistance within 6 days of gastric bypass by both IVGTT and HOMA methods in all groups, which was maintained over the 12-month period. The study included 31 diabetic patients, of whom only 3 required medication following hospital discharge.Conclusion: The changes in insulin resistance seen after gastric bypass, which are responsible for the resolution or improvement of type 2 diabetes occur within 6 days of the surgery, before any appreciable weight loss has occurred. This finding has implications for our understanding of the mechanism of insulin resistance in severely obese patients and is consistent with a humoral mechanism emanating from the GI tract.