GLP-1 and glucose tolerance after sleeve gastrectomy in morbidly obese subjects with type 2 diabetes.
Although GLP-1 has been suggested as a major factor for the marked improvement of glucose tolerance commonly seen after sleeve gastrectomy (SG), several observations challenge this hypothesis. To better understand the role of GLP-1 in the remission of type 2 diabetes mellitus (T2DM) long term after SG in humans, we conducted two separate cross-sectional studies: 1) the GLP-1 response to a standardized mixed liquid meal (SMLM) was compared in subjects with T2DM antedating SG but with different long-term (>2 years) T2DM outcomes (remission, relapse, or lack of remission) (study 1) and 2) the effect of GLP-1 receptor blockade with exendin (9-39) on glucose tolerance was examined in subjects with T2DM antedating surgery, who had undergone SG and presented with long-term T2DM remission (study 2). In study 1, we observed a comparable GLP-1 response to the SMLM regardless of the post-SG outcome of T2DM. In study 2, the blockade of GLP-1 action resulted in impaired insulin secretion but limited deterioration of glucose tolerance. Thus, our data suggest the enhanced GLP-1 secretion observed long term after SG is neither sufficient nor critical to maintain normal glucose tolerance in subjects with T2DM antedating the surgery.
Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Amanda
A
Jiménez
Consiglio Nazionale delle Ricerche Institute of Biomedical Engineering, Padua, Italy.
Andrea
A
Mari
Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain CIBERDEM, Barcelona, Spain.
Roser
R
Casamitjana
Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain CIBERDEM, Barcelona, Spain.
Antonio
A
Lacy
Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy.
Ele
E
Ferrannini
Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain CIBERDEM, Barcelona, Spain jovidal@clinic.ub.es.
Josep
J
Vidal
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D005260:Female; D005743:Gastrectomy; D052216:Glucagon-Like Peptide 1 / Q000097:blood*; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000378:metabolism* / Q000601:surgery
D001786:Blood Glucose; D052216:Glucagon-Like Peptide 1