Rise of oxyntomodulin in response to oral glucose after gastric bypass surgery in patients with type 2 diabetes.
BACKGROUND
The mechanisms by which Roux-en-Y gastric bypass surgery (GBP) results in sustained weight loss and remission of type 2 diabetes are not fully understood.


OBJECTIVE
We hypothesized that the anorexic hormone oxyntomodulin (OXM) might contribute to the marked weight reduction and the rapid improvement in glucose metabolism observed in morbidly obese diabetic patients after GBP.


METHODS
Twenty obese women with type 2 diabetes were studied before and 1 month after GBP (n=10) or after a diet-induced equivalent weight loss (n=10). Patients from both groups were matched for age, body weight, body mass index, and diabetes duration and control. OXM concentrations were measured during a 50-g oral glucose challenge before and after weight loss.


RESULTS
At baseline, OXM levels (fasting and stimulated values) were indistinguishable between the GBP and the diet group. However, OXM levels rose remarkably in response to an oral glucose load more than 2-fold (peak, 5.25+/-1.31 to13.8+/-16.2 pmol/liter; P=0.025) after GBP but not after diet. The peak of OXM after glucose was significantly correlated with glucagon-like peptide-1 and peptide YY3-36.


CONCLUSIONS
Our data suggest that the observed changes in OXM primarily occur in response to GBP and not as a consequence of weight loss. These changes were observed early after surgery and occurred in parallel with previously reported increases in incretins and peptide YY. We speculate that the combination of gut hormone changes is essential for the improved glucose homeostasis and may partially explain the success of this surgery on diabetes resolution and weight loss.
Laferrère
Blandine
B
Obesity Research Center, St Luke's Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA. BBL14@columbia.edu
Swerdlow
Nicholas
N
Bawa
Baani
B
Arias
Sara
S
Bose
Mousumi
M
Oliván
Blanca
B
Teixeira
Julio
J
McGinty
James
J
Rother
Kristina I
KI
D000328:Adult; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000601:surgery*; D004038:Diet, Reducing; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015390:Gastric Bypass; D005951:Glucose Tolerance Test; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism / Q000601:surgery*; D053772:Oxyntomodulin / Q000097:blood*; D011863:Radioimmunoassay; D016896:Treatment Outcome
D001786:Blood Glucose; D053772:Oxyntomodulin