title: Removal of duodenum elicits GLP-1 secretion.
abstract: OBJECTIVE
  To evaluate the effect of removal of the duodenum on the complex interplay between incretins, insulin, and glucagon in nondiabetic subjects.
  
  
  METHODS
  For evaluation of hormonal secretion and insulin sensitivity, 10 overweight patients without type 2 diabetes (age 61 ± 19.3 years and BMI 27.9 ± 5.3 kg/m(2)) underwent a mixed-meal test and a hyperinsulinemic-euglycemic clamp before and after pylorus-preserving pancreatoduodenectomy for ampulloma.
  
  
  RESULTS
  All patients experienced a reduction in insulin (P = 0.002), C-peptide (P = 0.0002), and gastric inhibitory peptide (GIP) secretion (P = 0.0004), while both fasting and postprandial glucose levels increased (P = 0.0001); GLP-1 and glucagon responses to the mixed meal increased significantly after surgery (P = 0.02 and 0.031). While changes in GIP levels did not correlate with insulin, glucagon, and glucose levels, the increase in GLP-1 secretion was inversely related to the postsurgery decrease in insulin secretion (R(2) = 0.56; P = 0.012) but not to the increased glucagon secretion, which correlated inversely with the reduction of insulin (R(2) = 0.46; P = 0.03) and C-peptide (R(2) = 0.37; P = 0.04). Given that the remaining pancreas presumably has preserved intraislet anatomy, insulin secretory capacity, and α- and β-cell interplay, our data suggest that the increased glucagon secretion is related to decreased systemic insulin.
  
  
  CONCLUSIONS
  Pylorus-preserving pancreatoduodenectomy was associated with a decrease in GIP and a remarkable increase in GLP-1 levels, which was not translated into increased insulin secretion. Rather, the hypoinsulinemia may have caused an increase in glucagon secretion.
authors: Division of Endocrinology and Metabolic Diseases, Università Cattolica del Sacro Cuore, Rome, Italy. giovanna.muscogiuri@gmail.com
authors: Giovanna
authors: G
authors: Muscogiuri
authors: Teresa
authors: T
authors: Mezza
authors: Annamaria
authors: A
authors: Prioletta
authors: Gian Pio
authors: GP
authors: Sorice
authors: Gennaro
authors: G
authors: Clemente
authors: Gerardo
authors: G
authors: Sarno
authors: Gennaro
authors: G
authors: Nuzzo
authors: Alfredo
authors: A
authors: Pontecorvi
authors: Jens J
authors: JJ
authors: Holst
authors: Andrea
authors: A
authors: Giaccari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005749:Gastric Inhibitory Polypeptide / Q000378:metabolism; D005934:Glucagon / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism*; D006801:Humans; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy
chemical_list: D007328:Insulin; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1; D005934:Glucagon
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