title: Hepatic and peripheral insulin sensitivity and diabetes remission at 1 month after Roux-en-Y gastric bypass surgery in patients randomized to omentectomy.
abstract: OBJECTIVE
  Early after Roux-en-Y gastric bypass (RYGB), there is improvement in type 2 diabetes, which is characterized by insulin resistance. We determined the acute effects of RYGB, with and without omentectomy, on hepatic and peripheral insulin sensitivity. We also investigated whether preoperative diabetes or postoperative diabetes remission influenced tissue-specific insulin sensitivity after RYGB.
  
  
  METHODS
  We studied 40 obese (BMI 48 ± 8 kg/m(2)) participants, 17 with diabetes. Participants were randomized to RYGB alone or in conjunction with omentectomy. Hyperinsulinemic-euglycemic clamps with isotopic-tracer infusion were completed at baseline and at 1 month postoperatively to assess insulin sensitivity.
  
  
  RESULTS
  Participants lost 11 ± 4% of body weight at 1 month after RYGB, without an improvement in peripheral insulin sensitivity; these outcomes were not affected by omentectomy, preoperative diabetes, or remission of diabetes. Hepatic glucose production (HGP) and the hepatic insulin sensitivity index improved in all subjects, irrespective of omentectomy (P ≤ 0.001). Participants with diabetes had higher baseline HGP values (P = 0.003) that improved to a greater extent after RYGB (P = 0.006). Of the 17 participants with diabetes, 10 (59%) had remission at 1 month. Diabetes remission had a group × time effect (P = 0.041) on HGP; those with diabetes remission had lower preoperative and postoperative HGP.
  
  
  CONCLUSIONS
  Peripheral insulin sensitivity did not improve 1 month after RYGB, irrespective of omentectomy, diabetes, or diabetes remission. Hepatic insulin sensitivity improved at 1 month after RYGB and was more pronounced in patients with diabetes. Improvement in HGP may influence diabetes remission early after RYGB.
authors: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. robyn.tamboli@vanderbilt.edu
authors: Julia P
authors: JP
authors: Dunn
authors: Naji N
authors: NN
authors: Abumrad
authors: Igal
authors: I
authors: Breitman
authors: Pamela A
authors: PA
authors: Marks-Shulman
authors: Charles Robb
authors: CR
authors: Flynn
authors: Kareem
authors: K
authors: Jabbour
authors: Irene D
authors: ID
authors: Feurer
authors: Robyn A
authors: RA
authors: Tamboli
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass; D015309:Glucose Clamp Technique; D006801:Humans; D007333:Insulin Resistance; D008099:Liver / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery; D009852:Omentum / Q000601:surgery*; D012074:Remission Induction; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose