title: Relevance of beta-cell function for improved glycemic control after gastric bypass surgery.
abstract: BACKGROUND
  Residual beta-cell function and gastrointestinal hormones have been suggested as relevant determinants of improved glycemic control ensuing Roux-en-Y gastric bypass (RYGB). The objective of this study was to compare the glycemic control up to 24 months after RYGB in C-peptide negative morbidly obese (MO) type 1 diabetes mellitus (T1 DM) women (n = 7) and C-peptide positive (>.6 ng/mL) MO women with type 2 diabetes mellitus (T2 DM, n = 7) on basal-bolus insulin therapy. The glucagon-like peptide 1 (GLP-1) and glucagon response to a mixed meal challenge were also compared between groups.
  
  
  METHODS
  Percent excess weight loss (%EWL), HbA1c, and daily insulin dose (DID) after RYGB were compared between groups. The GLP-1 and glucagon response (area under the curve 0-120 minutes) after a mixed meal at last follow-up visit were also compared.
  
  
  RESULTS
  At 24-months, marked %EWL was observed in women with T1 DM and women with T2 DM (mean±standard error, 82.6% ± 11.3% and 87.4% ± 30.5%, respectively; P = .722]. In women with T1 DM, HbA1c (4 months, P<.05) and DID improved transiently (P<.05, up to 8 months) but were comparable to baseline thereafter (HbA1c: baseline, 8.3 ± 1.2 and 24 months, 8.2 ± .9, P = 1.00; DID: baseline, .61 ± .17 and 24 months .62 ± .12 IU/kg/d, P = 1.00]. In contrast, in MO women with T2 DM, HbA1c decreased significantly throughout follow-up, with 2 patients presenting diabetes remission and all but one an HbA1c<7% at 24 months. The GLP-1 response was comparable between groups (P = .612), and was not accompanied by suppression of the glucagon response to meal intake.
  
  
  CONCLUSIONS
  In the absence of residual beta-cell, RYGB results in no significant benefit on glycemic control, despite a marked response of GLP-1 to meal intake.
authors.affiliation: Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Blanco
authors.affiliation: Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain.
authors.forename: Amanda
authors.initials: A
authors.lastname: Jiménez
authors.affiliation: Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Roser
authors.initials: R
authors.lastname: Casamitjana
authors.affiliation: Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Lílliam
authors.initials: L
authors.lastname: Flores
authors.affiliation: Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lacy
authors.affiliation: Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Conget
authors.affiliation: Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain. Electronic address: jovidal@clinic.ub.es.
authors.forename: Josep
authors.initials: J
authors.lastname: Vidal
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002096:C-Peptide / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D015390:Gastric Bypass; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D050417:Insulin-Secreting Cells / Q000502:physiology*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D002096:C-Peptide; D007004:Hypoglycemic Agents; D007328:Insulin; D052216:Glucagon-Like Peptide 1
keywords: Beta-cell; C-peptide; Gastric bypass; Type 1 diabetes mellitus; Type 2 diabetes mellitus