Dimitri J Pournaras1, Jonas Nygren2, Eva Hagström-Toft3, Peter Arner3, Carel W le Roux4, Anders Thorell2. 1. The Norfolk and Norwich Oesophagogastric Cancer Centre, Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK. Electronic address: dpournaras@doctors.org.uk. 2. Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. 3. Department of Medicine, H7, Karolinska Institutet, Stockholm, Sweden. 4. Diabetes Complication Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden; Investigative Science, Imperial College London, London, UK.
Abstract
BACKGROUND:Glucose metabolism is improved in patients with type 2 diabetes after Roux-en-Y gastric bypass (RYGB). OBJECTIVES: To quantify the relative contribution of calorie restriction, rerouting of nutrients, and adipose tissue reduction. SETTING: University Hospital. METHODS:Fifteen diabetic patients, (47±9 yr, body mass index 41.3±4.2 kg/m2) were randomized to a 2-week very low-calorie diet (VLCD) regimen or normal diet before RYGB. A euglycemic-hyperinsulinemic clamp, indirect calorimetry, and a standard meal test were performed prediet, postdiet (preoperatively), and 2 weeks and 12 months postoperatively. The primary outcome was whole-body insulin sensitivity (M) measured with the clamp 2 weeks postoperatively. RESULTS: In the VLCD group, after 2 weeks of calorie restriction, M improved (2.9±1.3 to 4.2±1.1 mg/kg/min, P = .005) with no further change at 2 weeks postoperatively. In the normal diet group 2 weeks postoperatively, M was similar to the VLCD group (4.7±1.7 versus 4.2±1.1, P = .61). One year postoperatively, M improved further in both groups. The improvement in insulin-stimulated glucose uptake after VLCD and RYGB was entirely accounted for by nonoxidative glucose disposal (NOGD), whereas weight loss at 1 year postoperatively was associated with an increase in NOGD and glucose oxidation. Postprandial glucose improved after VLCD (P<.05) and even more 2 weeks after RYGB (P<.05) with no further change after 1 year. CONCLUSION:Improved whole-body insulin sensitivity and postprandial glucose response occur early after RYGB. Low calorie intake and rerouting of nutrients contribute through distinct mechanisms. Weight loss contributes by increasing whole-body insulin sensitivity, including glucose oxidation and NOGD. These data suggest that the combination of different mechanisms is what makes RYGB an effective intervention for type 2 diabetes. Copyright Â
RCT Entities:
BACKGROUND:Glucose metabolism is improved in patients with type 2 diabetes after Roux-en-Y gastric bypass (RYGB). OBJECTIVES: To quantify the relative contribution of calorie restriction, rerouting of nutrients, and adipose tissue reduction. SETTING: University Hospital. METHODS: Fifteen diabeticpatients, (47±9 yr, body mass index 41.3±4.2 kg/m2) were randomized to a 2-week very low-calorie diet (VLCD) regimen or normal diet before RYGB. A euglycemic-hyperinsulinemic clamp, indirect calorimetry, and a standard meal test were performed prediet, postdiet (preoperatively), and 2 weeks and 12 months postoperatively. The primary outcome was whole-body insulin sensitivity (M) measured with the clamp 2 weeks postoperatively. RESULTS: In the VLCD group, after 2 weeks of calorie restriction, M improved (2.9±1.3 to 4.2±1.1 mg/kg/min, P = .005) with no further change at 2 weeks postoperatively. In the normal diet group 2 weeks postoperatively, M was similar to the VLCD group (4.7±1.7 versus 4.2±1.1, P = .61). One year postoperatively, M improved further in both groups. The improvement in insulin-stimulated glucose uptake after VLCD and RYGB was entirely accounted for by nonoxidative glucose disposal (NOGD), whereas weight loss at 1 year postoperatively was associated with an increase in NOGD and glucose oxidation. Postprandial glucose improved after VLCD (P<.05) and even more 2 weeks after RYGB (P<.05) with no further change after 1 year. CONCLUSION: Improved whole-body insulin sensitivity and postprandial glucose response occur early after RYGB. Low calorie intake and rerouting of nutrients contribute through distinct mechanisms. Weight loss contributes by increasing whole-body insulin sensitivity, including glucose oxidation and NOGD. These data suggest that the combination of different mechanisms is what makes RYGB an effective intervention for type 2 diabetes. Copyright Â
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