Early improvement in glycemic control after bariatric surgery and its relationships with insulin, GLP-1, and glucagon secretion in type 2 diabetic patients.

摘要

BACKGROUND: The surgical treatment of obesity ameliorates metabolic abnormalities in patients with type 2 diabetes. The objective of this study was to evaluate the early effects of Roux-en-Y gastric bypass (RYGB) on metabolic and hormonal parameters in patients with type 2 diabetes (T2DM). METHODS: Ten patients with T2DM (BMI, 39.7 +/- 1.9) were evaluated before and 7, 30, and 90 days after RYGB. A meal test was performed, and plasma insulin, glucose, glucagon, and glucagon-like-peptide 1 (GLP-1) levels were measured at fasting and postprandially. RESULTS: Seven days after RYGB, a significant reduction was observed in HOMA-IR index from 7.8 +/- 5.5 to 2.6 +/- 1.7; p < 0.05 was associated with a nonsignificant reduction in body weight. The insulin and GLP-1 curves began to show a peak at 30 min after food ingestion, while there was a progressive decrease in glucagon and blood glucose levels throughout the meal test. Thirty and 90 days after RYGB, along with progressive weight loss, blood glucose and hormonal changes remained in the same direction and became more expressive with the post-meal insulin curve suggesting recovery of the first phase of insulin secretion and with the increase in insulinogenic index, denoting improvement in beta-cell function. Furthermore, a positive correlation was found between changes in GLP-1 and insulin levels measured at 30 min after meal (r = 0.6; p = 0.000). CONCLUSION: Our data suggest that the RYGB surgery, beyond weight loss, induces early beneficial hormonal changes which favor glycemic control in type 2 diabetes.