title: Acute improvement in insulin resistance after laparoscopic Roux-en-Y gastric bypass: is 3 days enough to correct insulin metabolism?
abstract: BACKGROUND
  Although medium- to long-term improvement in insulin resistance and T2DM after Roux-en-Y gastric bypass (RYGB) is well documented, few studies have analyzed the acute effects after surgery. Understanding these effects might help explain the physiologic adjustments after surgery and help in managing insulin resistance and controlling the hypoglycemic treatment for bariatric patients.
  
  
  METHODS
  We recruited a prospective cohort of 55 consecutive female patients that underwent primary laparoscopic RYGB between January and June/2011. Blood samples were collected preoperatively and at the first, third, and fifth post-operative days after an overnight fast.
  
  
  RESULTS
  There was a significant increase in homeostasis model assessment for insulin resistance (HOMA-IR) on day 1 (2.36 vs 3.12; p = 0.032), followed by a rapid decrease from day 3 onward (3.12 vs 1.70; <0.001). We found a statistically significant difference (p < 0.05) at all time points compared with baseline. HOMA-IR levels at POD5 were 47 % lower than baseline values and were not significantly different from values at 6 months (1.24 vs 0.93; p = 0.09). The blood levels of glucose and insulin closely matched those of HOMA-IR.
  
  
  CONCLUSIONS
  RYGB results in a rapid improvement in insulin resistance and a clinically significant decrease in fasting glucose and insulin levels. This improvement is significant at the 3rd post-operative day, and by the 5th day, patients express insulin resistance levels that are similar to those expressed at 6 months after surgery. This work highlights the acute metabolic impact of surgery. Understanding the behavior of insulin and glucose after surgery might improve our knowledge of the pathophysiology of diabetes and lead to novel therapies and tailored surgical approaches.
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Porto, Porto, Portugal. gilrfaria@gmail.com
authors.forename: Gil
authors.initials: G
authors.lastname: Faria
authors.forename: John
authors.initials: J
authors.lastname: Preto
authors.forename: Eduardo Lima
authors.initials: EL
authors.lastname: da Costa
authors.forename: João Tiago
authors.initials: JT
authors.lastname: Guimarães
authors.forename: Conceição
authors.initials: C
authors.lastname: Calhau
authors.forename: António
authors.initials: A
authors.lastname: Taveira-Gomes
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009767:Obesity, Morbid / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D013997:Time Factors; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human