title: GLP-1 response to a mixed meal: what happens 10 years after Roux-en-Y gastric bypass (RYGB)?
abstract: BACKGROUND
  Oral meal consumption increases glucagon-like peptide 1 (GLP-1) release which maintains euglycemia by increasing insulin secretion. This effect is exaggerated during short-term follow-up of Roux-en-y gastric bypass (RYGB). We examined the durability of this effect in patient with type 2 diabetes (T2DM) >10 years after RYGB.
  
  
  METHODS
  GLP-1 response to a mixed meal in the 10-year post-RYGB group (n = 5) was compared to lean (n = 9), obese (n = 6), and type 2 diabetic (n = 10) controls using a cross-sectional study design. Analysis of variance (ANOVA) was used to evaluate GLP-1 response to mixed meal consumption from 0 to 300 min, 0-20 min, 20-60 min, and 60-300 min, respectively. Weight, insulin resistance, and T2DM were also assessed.
  
  
  RESULTS
  GLP-1 response 0-300 min in the 10-year post-RYGB showed a statistically significant overall difference (p =  0.01) compared to controls. Furthermore, GLP-1 response 0-20 min in the 10-year post-RYGB group showed a very rapid statistically significant rise (p = 0.035) to a peak of 40 pM. GLP-1 response between 20 and 60 min showed a rapid statistically significant (p = 0.041) decline in GLP-1 response from ~40 pM to 10 pM. GLP-1 response in the 10-year post-RYGB group from 60 to 300 min showed no statistically significant difference from controls. BMI, HOMA, and fasting serum glucose before and >10 years after RYGB changed from 59.9 → 40.4, 8.7 → 0.88, and 155.2 → 87.6 mg/dl, respectively, and were statistically significant (p < 0.05).
  
  
  CONCLUSIONS
  An exaggerated GLP-1 response was noted 10 years after RYGB, strongly suggesting a durability of this effect. This phenomenon may play a key role in maintaining type 2 diabetes remission and weight loss after RYGB.
authors.affiliation: Department of Internal Medicine, Section of Endocrinology & Metabolism, Brody School of Medicine at East Carolina University, 3E-129 Brody Building, 600 Moye Boulevard, Greenville, NC 27834, USA. darmo@ecu.edu
authors.forename: Moahad S
authors.initials: MS
authors.lastname: Dar
authors.forename: William H
authors.initials: WH
authors.lastname: Chapman
authors.forename: John R
authors.initials: JR
authors.lastname: Pender
authors.forename: Almond J
authors.initials: AJ
authors.lastname: Drake
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Brien
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Tanenberg
authors.forename: G Lynis
authors.initials: GL
authors.lastname: Dohm
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
mesh_terms: D000704:Analysis of Variance; D001786:Blood Glucose / Q000378:metabolism*; D001835:Body Weight; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy / Q000601:surgery; D004435:Eating; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D052216:Glucagon-Like Peptide 1 / Q000097:blood* / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood* / Q000188:drug therapy / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human