title: Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes.
abstract: BACKGROUND
  Gastric bypass surgery (GBP) results in rapid weight loss, improvement of type 2 diabetes (T2DM), and increase in incretins levels. Diet-induced weight loss also improves T2DM and may increase incretin levels.
  
  
  OBJECTIVE
  Our objective was to determine whether the magnitude of the change of the incretin levels and effect is greater after GBP compared with a low caloric diet, after equivalent weight loss.
  
  
  METHODS
  Obese women with T2DM studied before and 1 month after GBP (n = 9), or after a diet-induced equivalent weight loss (n = 10), were included in the study. Patients from both groups were matched for age, body weight, body mass index, diabetes duration and control, and amount of weight loss.
  
  
  METHODS
  This outpatient study was conducted at the General Clinical Research Center.
  
  
  METHODS
  Glucose, insulin, proinsulin, glucagon, gastric inhibitory peptide (GIP), and glucagon-like peptide (GLP)-1 levels were measured after 50-g oral glucose. The incretin effect was measured as the difference in insulin levels in response to oral and to an isoglycemic iv glucose load.
  
  
  RESULTS
  At baseline, none of the outcome variables (fasting and stimulated values) were different between the GBP and diet groups. Total GLP-1 levels after oral glucose markedly increased six 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) after GBP, but not after diet. Postprandial glucose levels (P = 0.001) decreased more after GBP.
  
  
  CONCLUSIONS
  These data suggest that early after GBP, the greater GLP-1 and GIP release and improvement of incretin effect are related not to weight loss but rather to the surgical procedure. This could be responsible for better diabetes outcome after GBP.
authors.affiliation: St. Lukes Roosevelt Hospital, Obesity Research Center, 1111 Amsterdam Avenue, New York, NY 10025, USA. BBL14@columbia.edu
authors.forename: Blandine
authors.initials: B
authors.lastname: Laferrère
authors.forename: Julio
authors.initials: J
authors.lastname: Teixeira
authors.forename: James
authors.initials: J
authors.lastname: McGinty
authors.forename: Hao
authors.initials: H
authors.lastname: Tran
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Egger
authors.forename: Antonia
authors.initials: A
authors.lastname: Colarusso
authors.forename: Betty
authors.initials: B
authors.lastname: Kovack
authors.forename: Baani
authors.initials: B
authors.lastname: Bawa
authors.forename: Ninan
authors.initials: N
authors.lastname: Koshy
authors.forename: Hongchan
authors.initials: H
authors.lastname: Lee
authors.forename: Kimberly
authors.initials: K
authors.lastname: Yapp
authors.forename: Blanca
authors.initials: B
authors.lastname: Olivan
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D004038:Diet, Reducing; D005260:Female; D015390:Gastric Bypass; D005749:Gastric Inhibitory Polypeptide / Q000097:blood; D005934:Glucagon / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006801:Humans; D054795:Incretins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000628:therapy*; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D054795:Incretins; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1; D005934:Glucagon