title: Limited recovery of β-cell function after gastric bypass despite clinical diabetes remission.
abstract: The mechanisms responsible for the remarkable remission of type 2 diabetes after Roux-en-Y gastric bypass (RYGBP) are still puzzling. To elucidate the role of the gut, we compared β-cell function assessed during an oral glucose tolerance test (OGTT) and an isoglycemic intravenous glucose clamp (iso-IVGC) in: 1) 16 severely obese patients with type 2 diabetes, up to 3 years post-RYGBP; 2) 11 severely obese normal glucose-tolerant control subjects; and 3) 7 lean control subjects. Diabetes remission was observed after RYGBP. β-Cell function during the OGTT, significantly blunted prior to RYGBP, normalized to levels of both control groups after RYGBP. In contrast, during the iso-IVGC, β-cell function improved minimally and remained significantly impaired compared with lean control subjects up to 3 years post-RYGBP. Presurgery, β-cell function, weight loss, and glucagon-like peptide 1 response were all predictors of postsurgery β-cell function, although weight loss appeared to be the strongest predictor. These data show that β-cell dysfunction persists after RYGBP, even in patients in clinical diabetes remission. This impairment can be rescued by oral glucose stimulation, suggesting that RYGBP leads to an important gastrointestinal effect, critical for improved β-cell function after surgery.
authors.affiliation: Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Dutia
authors.forename: Katrina
authors.initials: K
authors.lastname: Brakoniecki
authors.forename: Phoebe
authors.initials: P
authors.lastname: Bunker
authors.forename: Furcy
authors.initials: F
authors.lastname: Paultre
authors.forename: Peter
authors.initials: P
authors.lastname: Homel
authors.forename: André C
authors.initials: AC
authors.lastname: Carpentier
authors.forename: James
authors.initials: J
authors.lastname: McGinty
authors.forename: Blandine
authors.initials: B
authors.lastname: Laferrère
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000601:surgery*; D015390:Gastric Bypass; D041981:Gastrointestinal Tract / Q000502:physiology*; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006801:Humans; D050417:Insulin-Secreting Cells / Q000502:physiology*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery; D012074:Remission Induction; D015431:Weight Loss
chemical_list: D001786:Blood Glucose