Effect of Weight Loss by Gastric Bypass Surgery Versus Hypocaloric Diet on Glucose and Incretin Levels in Patients with Type 2 Diabetes
Blandine Laferrère,
Julio Teixeira,
James McGinty,
Hao Tran,
Joseph R. Egger,
Antonia Colarusso,
Betty Kovack,
Baani Bawa,
Ninan Koshy,
Hongchan Lee,
Kimberly Yapp and
Blanca Olivan
Obesity Research Center (B.L., H.T., J.R.E., A.C., B.K., B.B., K.Y., B.O.) and Bariatric Division (J.T., J.M., N.K., H.L.), St. Luke’s/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025
Address all correspondence and requests for reprints to: Dr. Blandine Laferrère, St. Lukes Roosevelt Hospital, Obesity Research Center, 1111 Amsterdam Avenue, Room 1020 Babcock, New York, New York 10025. E-mail: BBL14{at}columbia.edu.
Context: Gastric bypass surgery (GBP) results in rapid weightloss, improvement of type 2 diabetes (T2DM), and increase inincretins levels. Diet-induced weight loss also improves T2DMand may increase incretin levels.
Objective: Our objective was to determine whether the magnitudeof the change of the incretin levels and effect is greater afterGBP compared with a low caloric diet, after equivalent weightloss.
Design and Methods: Obese women with T2DM studied before and1 month after GBP (n = 9), or after a diet-induced equivalentweight loss (n = 10), were included in the study. Patients fromboth groups were matched for age, body weight, body mass index,diabetes duration and control, and amount of weight loss.
Setting: This outpatient study was conducted at the GeneralClinical Research Center.
Main Outcome Measures: Glucose, insulin, proinsulin, glucagon,gastric inhibitory peptide (GIP), and glucagon-like peptide(GLP)-1 levels were measured after 50-g oral glucose. The incretineffect was measured as the difference in insulin levels in responseto oral and to an isoglycemic iv glucose load.
Results: At baseline, none of the outcome variables (fastingand stimulated values) were different between the GBP and dietgroups. Total GLP-1 levels after oral glucose markedly increasedsix times (peak:17 ± 6 to 112 ± 54 pmol/liter;P < 0.001), and the incretin effect increased five times(9.4 ± 27.5 to 44.8 ± 12.7%; P < 0.001) afterGBP, but not after diet. Postprandial glucose levels (P = 0.001)decreased more after GBP.
Conclusions: These data suggest that early after GBP, the greaterGLP-1 and GIP release and improvement of incretin effect arerelated not to weight loss but rather to the surgical procedure.This could be responsible for better diabetes outcome afterGBP.
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