title: Laparoscopic greater curvature plication in morbidly obese women with type 2 diabetes: effects on glucose homeostasis, postprandial triglyceridemia and selected gut hormones.
abstract: BACKGROUND
  Laparoscopic greater curvature plication (LGCP) is an emerging bariatric procedure that reduces the gastric volume without implantable devices or gastrectomy. The aim of this study was to explore changes in glucose homeostasis, postprandial triglyceridemia, and meal-stimulated secretion of selected gut hormones [glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide-1 (GLP-1), ghrelin, and obestatin] in patients with type 2 diabetes mellitus (T2DM) at 1 and 6 months after the procedure.
  
  
  METHODS
  Thirteen morbidly obese T2DM women (mean age, 53.2 ± 8.76 years; body mass index, 40.1 ± 4.59 kg/m2) were prospectively investigated before the LGCP and at 1- and 6-month follow-up. At these time points, all study patients underwent a standardized liquid mixed-meal test, and blood was sampled for assessment of plasma levels of glucose, insulin, C-peptide, triglycerides, GIP, GLP-1, ghrelin, and obestatin.
  
  
  RESULTS
  All patients had significant weight loss both at 1 and 6 months after the LGCP (p ≤ 0.002), with mean percent excess weight loss (%EWL) reaching 29.7 ± 2.9% at the 6-month follow-up. Fasting hyperglycemia and hyperinsulinemia improved significantly at 6 months after the LGCP (p < 0.05), with parallel improvement in insulin sensitivity and HbA1c levels (p < 0.0001). Meal-induced glucose plasma levels were significantly lower at 6 months after the LGCP (p < 0.0001), and postprandial triglyceridemia was also ameliorated at the 6-month follow-up (p < 0.001). Postprandial GIP plasma levels were significantly increased both at 1 and 6 months after the LGCP (p < 0.0001), whereas the overall meal-induced GLP-1 response was not significantly changed after the procedure (p > 0.05). Postprandial ghrelin plasma levels decreased at 1 and 6 months after the LGCP (p < 0.0001) with no significant changes in circulating obestatin levels.
  
  
  CONCLUSIONS
  During the initial 6-month postoperative period, LGCP induces significant weight loss and improves the metabolic profile of morbidly obese T2DM patients, while it also decreases circulating postprandial ghrelin levels and increases the meal-induced GIP response.
authors.affiliation: Institute of Endocrinology, Narodni 8, Prague 1, 116 94, Czech Republic, obradnova@endo.cz.
authors.forename: Olga
authors.initials: O
authors.lastname: Bradnova
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kyrou
authors.forename: Vojtech
authors.initials: V
authors.lastname: Hainer
authors.forename: Josef
authors.initials: J
authors.lastname: Vcelak
authors.forename: Tereza
authors.initials: T
authors.lastname: Halkova
authors.forename: Petra
authors.initials: P
authors.lastname: Sramkova
authors.forename: Karin
authors.initials: K
authors.lastname: Dolezalova
authors.forename: Martin
authors.initials: M
authors.lastname: Fried
authors.forename: Philip
authors.initials: P
authors.lastname: McTernan
authors.forename: Sudhesh
authors.initials: S
authors.lastname: Kumar
authors.forename: Martin
authors.initials: M
authors.lastname: Hill
authors.forename: Marie
authors.initials: M
authors.lastname: Kunesova
authors.forename: Bela
authors.initials: B
authors.lastname: Bendlova
authors.forename: Jana
authors.initials: J
authors.lastname: Vrbikova
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005749:Gastric Inhibitory Polypeptide / Q000378:metabolism; D005768:Gastrointestinal Hormones / Q000378:metabolism; D015391:Gastroplasty / Q000379:methods*; D054439:Ghrelin / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism*; D006706:Homeostasis; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000378:metabolism / Q000601:surgery*; D019518:Postprandial Period; D013997:Time Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000378:metabolism*; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D005768:Gastrointestinal Hormones; D054439:Ghrelin; D014280:Triglycerides; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1