Proglucagon peptide secretion profiles in type 2 diabetes before and after bariatric surgery: 1-year prospective study
Proglucagon peptide secretion profiles in type 2 diabetes before and after bariatric surgery: 1-year prospective study
复制标题
DOI：
10.1136/bmjdrc-2019-001076
复制
发表时间：
2020-01-01
影响因子：
4.1
通讯作者：
Tan, Tricia M-M
中科院分区：
文献类型：
--
作者：
Alexiadou, Kleopatra;Cuenco, Joyceline;Tan, Tricia M-M
前言高胰高血糖素血症是2型糖尿病的一个重要病理生理驱动因素。虽然Roux-en-Y胃旁路术（RYGB）是一种非常有效的糖尿病治疗方法，但目前尚不清楚手术如何改变胰高血糖素生理学。本研究的目的是表征的行为胰高血糖素原衍生肽（胰高血糖素，胰高血糖素样肽-1（GLP-1），胃泌酸调节素，glicentin）分泌后RYGB surgery.Research design and methodsProspective study of 19 patients with obesity and pre-diabetes/diabetes undergoing RYGB。我们在术前和术后1、3和12个月评估了葡萄糖、胰岛素、GLP-1、葡萄糖依赖性促胰岛素肽（GIP）、胃泌酸调节素、胰高血糖素和胰高血糖素对混合餐试验（MMT）的反应。胰高血糖素测定使用Mercodia胰高血糖素ELISA使用的“替代”改进的特异性协议，这是验证对参考液相色谱法结合质谱method.ResultsAfter，有早期改善空腹血糖和葡萄糖耐量和胰岛素反应MMT加速和放大，平行显着增加餐后GLP-1，胃泌酸调节素和glicentin分泌。在术后3个月和12个月的后期时间点，空腹胰高血糖素水平显著降低。所有患者术前和术后均分泌胰高血糖素以响应MMT，餐后分泌无显著变化。GIP分泌无明显变化。ConclusionsThere是一个明显的差异后RYGB的胰高血糖素原肽的分泌动力学。空腹胰高血糖素分泌的减少可能是RYGB后血糖改善的机制之一。试验注册号NCT 01945840。
IntroductionHyperglucagonemia is a key pathophysiological driver of type 2 diabetes. Although Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for diabetes, it is presently unclear how surgery alters glucagon physiology. The aim of this study was to characterize the behavior of proglucagon-derived peptide (glucagon, glucagon-like peptide-1 (GLP-1), oxyntomodulin, glicentin) secretion after RYGB surgery.Research design and methodsProspective study of 19 patients with obesity and pre-diabetes/diabetes undergoing RYGB. We assessed the glucose, insulin, GLP-1, glucose-dependent insulinotropic peptide (GIP), oxyntomodulin, glicentin and glucagon responses to a mixed-meal test (MMT) before and 1, 3 and 12 months after surgery. Glucagon was measured using a Mercodia glucagon ELISA using the 'Alternative' improved specificity protocol, which was validated against a reference liquid chromatography combined with mass spectrometry method.ResultsAfter RYGB, there were early improvements in fasting glucose and glucose tolerance and the insulin response to MMT was accelerated and amplified, in parallel to significant increases in postprandial GLP-1, oxyntomodulin and glicentin secretion. There was a significant decrease in fasting glucagon levels at the later time points of 3 and 12 months after surgery. Glucagon was secreted in response to the MMT preoperatively and postoperatively in all patients and there was no significant change in this postprandial secretion. There was no significant change in GIP secretion.ConclusionsThere is a clear difference in the dynamics of secretion of proglucagon peptides after RYGB. The reduction in fasting glucagon secretion may be one of the mechanisms driving later improvements in glycemia after RYGB.Trial registration numberNCT01945840.