BACKGROUND: Although medium- to long-term improvement in insulin resistance and T2DM after Roux-en-Y gastric bypass (RYGB) is well documented, few studies have analyzed the acute effects after surgery. Understanding these effects might help explain the physiologic adjustments after surgery and help in managing insulin resistance and controlling the hypoglycemic treatment for bariatric patients. METHODS: We recruited a prospective cohort of 55 consecutive female patients that underwent primary laparoscopic RYGB between January and June/2011. Blood samples were collected preoperatively and at the first, third, and fifth post-operative days after an overnight fast. RESULTS: There was a significant increase in homeostasis model assessment for insulin resistance (HOMA-IR) on day 1 (2.36 vs 3.12; p = 0.032), followed by a rapid decrease from day 3 onward (3.12 vs 1.70; <0.001). We found a statistically significant difference (p < 0.05) at all time points compared with baseline. HOMA-IR levels at POD5 were 47 % lower than baseline values and were not significantly different from values at 6 months (1.24 vs 0.93; p = 0.09). The blood levels of glucose and insulin closely matched those of HOMA-IR. CONCLUSIONS: RYGB results in a rapid improvement in insulin resistance and a clinically significant decrease in fasting glucose and insulin levels. This improvement is significant at the 3rd post-operative day, and by the 5th day, patients express insulin resistance levels that are similar to those expressed at 6 months after surgery. This work highlights the acute metabolic impact of surgery. Understanding the behavior of insulin and glucose after surgery might improve our knowledge of the pathophysiology of diabetes and lead to novel therapies and tailored surgical approaches.
BACKGROUND: Although medium- to long-term improvement in insulin resistance and T2DM after Roux-en-Y gastric bypass (RYGB) is well documented, few studies have analyzed the acute effects after surgery. Understanding these effects might help explain the physiologic adjustments after surgery and help in managing insulin resistance and controlling the hypoglycemic treatment for bariatric patients. METHODS: We recruited a prospective cohort of 55 consecutive female patients that underwent primary laparoscopic RYGB between January and June/2011. Blood samples were collected preoperatively and at the first, third, and fifth post-operative days after an overnight fast. RESULTS: There was a significant increase in homeostasis model assessment for insulin resistance (HOMA-IR) on day 1 (2.36 vs 3.12; p = 0.032), followed by a rapid decrease from day 3 onward (3.12 vs 1.70; <0.001). We found a statistically significant difference (p < 0.05) at all time points compared with baseline. HOMA-IR levels at POD5 were 47 % lower than baseline values and were not significantly different from values at 6 months (1.24 vs 0.93; p = 0.09). The blood levels of glucose and insulin closely matched those of HOMA-IR. CONCLUSIONS: RYGB results in a rapid improvement in insulin resistance and a clinically significant decrease in fasting glucose and insulin levels. This improvement is significant at the 3rd post-operative day, and by the 5th day, patients express insulin resistance levels that are similar to those expressed at 6 months after surgery. This work highlights the acute metabolic impact of surgery. Understanding the behavior of insulin and glucose after surgery might improve our knowledge of the pathophysiology of diabetes and lead to novel therapies and tailored surgical approaches.
Authors: Melissa A Reed; Walter J Pories; William Chapman; John Pender; Rita Bowden; Hisham Barakat; Timothy P Gavin; Tom Green; Ed Tapscott; Donghai Zheng; Nigel Shankley; Lynn Yieh; David Polidori; Steven P Piccoli; Leona Brenner-Gati; G Lynis Dohm Journal: J Clin Endocrinol Metab Date: 2011-05-18 Impact factor: 5.958
Authors: Geoffrey J Service; Geoffrey B Thompson; F John Service; James C Andrews; Maria L Collazo-Clavell; Ricardo V Lloyd Journal: N Engl J Med Date: 2005-07-21 Impact factor: 91.245
Authors: Camila Puzzi de Carvalho; Daniela Miguel Marin; Aglécio Luiz de Souza; José Carlos Pareja; Elintom Adami Chaim; Silvia de Barros Mazon; Conceição Aparecida da Silva; Bruno Geloneze; Elza Muscelli; Sarah Monte Alegre Journal: Obes Surg Date: 2008-09-25 Impact factor: 4.129
Authors: James M Isbell; Robyn A Tamboli; Erik N Hansen; Jabbar Saliba; Julia P Dunn; Sharon E Phillips; Pamela A Marks-Shulman; Naji N Abumrad Journal: Diabetes Care Date: 2010-04-05 Impact factor: 19.112
Authors: Francesco Rubino; Michel Gagner; Paolo Gentileschi; Subhash Kini; Shoji Fukuyama; John Feng; Ed Diamond Journal: Ann Surg Date: 2004-08 Impact factor: 12.969