Mechanisms of Diabetes Control After Weight Loss Surgery

6-摘要- 胃旁路手术（GBP）后2型糖尿病（T2 DM）缓解的机制是 不清楚肠道激素肠促胰岛素的水平及其对胰岛素分泌的影响， 在T2 DM中受损，在GBP后显著增加。GBP的解剖学变化， 而不是体重减轻，似乎是肠促胰岛素变化的原因。的目的 建议是调查GBP和胃束带（GB）的不同机制， 影响血糖控制。 我们希望了解在短期内减肥与肠道肽变化的作用， 在随机分配至GBP或GB的T2 DM病态患者中进行长期研究。 目的1比较GBP和GB对肠促胰岛素水平的短期影响， 在相当于10 kg体重减轻后，检验肠促胰岛素水平和作用 在GBP之后的增长将大于GB之后的增长。 目的2研究口服葡萄糖后肠促胰岛素水平的长期变化及其影响 在GBP和GB之前和之后2年的24小时多餐饮食期间，测试 假设GBP后肠促胰岛素平均水平高于GB后。 目的3将研究胰岛素分泌对静脉葡萄糖（AIRg）的反应变化， 胰岛素敏感性（Si），通过最小模型测量，GBP和GB后2年， 检验假设，即对于Si的等效增加，AIRg将在 GBP比GB后。

6-Abstract- The mechanisms of type 2 diabetes (T2DM) remission after gastric bypass surgery (GBP) are unclear. The levels of the gut hormones incretins and their effect on insulin secretion, which is impaired in T2DM, markedly increase after GBP. The anatomical changes of GBP, rather than weight loss, seem to be responsible for the changes of incretins. The objective of this proposal is to investigate the different mechanisms by which GBP and gastric banding (GB) affect glucose control. We wish to understand the role of weight loss versus changes in gut peptides in the short and long term in morbidly patients with T2DM randomized to GBP or GB. AIM 1 will compare the short term effect of GBP and GB on incretin levels and effect after an equivalent 10 kg weight loss, testing the hypothesis that incretin levels and effect will increase more after GBP than after GB. AIM 2 will study the long-term changes in the incretin levels and effect after oral glucose and during a 24-h multiple meal diet, before and 2 years after GBP and GB, testing the hypothesis that mean incretin levels is greater after GBP than after GB. AIM 3 will study the changes of insulin secretion in response to IV glucose (AIRg) and insulin sensitivity (Si), measured by the minimal model, 2 years after GBP and GB, testing the hypothesis that for an equivalent increase of Si, AIRg will increase more after GBP than after GB.