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Acute and long-term effects of Roux-en-Y gastric bypass on glucose metabolism in subjects with Type 2 diabetes and normal glucose tolerance

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  1. The renal extraction and the natriuretic action of GLP-1 in humans depend on interaction with the GLP-1 receptor

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  2. Counterregulatory responses to postprandial hypoglycemia after Roux-en-Y gastric bypass

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  3. Gut Mucosal Gene Expression and Metabolic Changes After Roux-en-Y Gastric Bypass Surgery

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Our aim was to study the potential mechanisms responsible for the improvement in glucose control in Type 2 diabetes (T2D) within days after Roux-en-Y gastric bypass (RYGB). Thirteen obese subjects with T2D and twelve matched subjects with normal glucose tolerance (NGT) were examined during a liquid meal before (Pre), 1 wk, 3 mo, and 1 yr after RYGB. Glucose, insulin, C-peptide, glucagon-like peptide-1 (GLP-1), glucose-dependent-insulinotropic polypeptide (GIP), and glucagon concentrations were measured. Insulin resistance (HOMA-IR), β-cell glucose sensitivity (β-GS), and disposition index (D(β-GS): β-GS × 1/HOMA-IR) were calculated. Within the first week after RYGB, fasting glucose [T2D Pre: 8.8 ± 2.3, 1 wk: 7.0 ± 1.2 (P <0.001)], and insulin concentrations decreased significantly in both groups. At 129 min, glucose concentrations decreased in T2D [Pre: 11.4 ± 3, 1 wk: 8.2 ± 2 (P = 0.003)] but not in NGT. HOMA-IR decreased by 50% in both groups. β-GS increased in T2D [Pre: 1.03 ± 0.49, 1 wk: 1.70 ± 1.2, (P = 0.012)] but did not change in NGT. The increase in DI(β-GS) was 3-fold in T2D and 1.5-fold in NGT. After RYGB, glucagon secretion was increased in response to the meal. GIP secretion was unchanged, while GLP-1 secretion increased more than 10-fold in both groups. The changes induced by RYGB were sustained or further enhanced 3 mo and 1 yr after surgery. Improvement in glycemic control in T2D after RYGB occurs within days after surgery and is associated with increased insulin sensitivity and improved β-cell function, the latter of which may be explained by dramatic increases in GLP-1 secretion.
Original languageEnglish
JournalAmerican Journal of Physiology: Endocrinology and Metabolism
Volume303
Issue number1
Pages (from-to)E122-31
ISSN0193-1849
DOIs
Publication statusPublished - 2012

    Research areas

  • Adult, Body Mass Index, C-Peptide, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Gastric Bypass, Glucagon, Glucagon-Like Peptide 1, Glucose, Humans, Hyperglycemia, Insulin Resistance, Insulin-Secreting Cells, Male, Middle Aged, Obesity, Obesity, Morbid, Postprandial Period, Time Factors

ID: 36754218