title: Temporal changes in glucose homeostasis and incretin hormone response at 1 and 6 months after laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  Bariatric surgery is an effective treatment for morbid obesity. Current literature reports significant improvements in glucose homeostasis after malabsorptive surgery. There is limited evidence on the effects of laparoscopic sleeve gastrectomy (SG) on glucose-insulin homeostasis and postoperative incretin hormone response. The objective of this study was to examine the metabolic effects of SG on temporal changes in insulin and glucose homeostasis, incretin hormones and hepatic insulin clearance in patients with impaired glucose tolerance (IGT) and type 2 diabetes (T2 DM).
  
  
  METHODS
  A nonrandomized prospective study comprising 22 participants undergoing SG (body mass index [BMI] 50.1 kg/m(2), glycated hemoglobin [HbA1c] 53 mmol/mol) and 15 participants undergoing biliopancreatic diversion (BPD) (BMI 62.1 kg/m(2), HbA1c 58 mmol/mol). Serial measurements of glucose, insulin, C-peptide, glucagon like peptide-1 (GLP-1) and glucose-dependent insulinotropic hormone (GIP) were performed during oral glucose tolerance testing preoperatively and 1 and 6 months postoperatively. Areas under the curve (AUC) were examined at 30, 60, and 120 minutes.
  
  
  RESULTS
  Within the SG group, significant improvements were observed respectively at 1 and 6 months in glucose control (HbA1c: -0.9%, -1.3%), measures of insulin sensitivity (fasting insulin: -4.8 mU/L, -8.5 mU/L; fasting C-peptide: -0.6 pmol/L, -1.1 pmol/L; Homeostasis Model Assessment [HOMA-IR]: -0.144, -0.174; HOMA %S:+29.6,+92.4), hepatic insulin clearance (+0.07,+0.13) and postprandial GLP-1 response (AUC0-30 pmol h L(-1):+300,+331, AUC0-60:+300,+294, AUC0-120:+316,+295). These results were comparable to the BPD group.
  
  
  CONCLUSIONS
  SG is associated with significant early improvements in insulin sensitivity and incretin hormone response and results in significant improvements in IGT/T2 DM.
authors.affiliation: Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea, United Kingdom; Department of Diabetes & Endocrinology, Morriston Hospital ABM University Health Board, Swansea, United Kingdom. Electronic address: mallipedhi@doctors.org.uk.
authors.forename: Akhila
authors.initials: A
authors.lastname: Mallipedhi
authors.affiliation: Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea, United Kingdom.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Prior
authors.affiliation: Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital ABM University Health Board, Swansea, United Kingdom.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Barry
authors.affiliation: Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital ABM University Health Board, Swansea, United Kingdom.
authors.forename: Scott
authors.initials: S
authors.lastname: Caplin
authors.affiliation: Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital ABM University Health Board, Swansea, United Kingdom.
authors.forename: John N
authors.initials: JN
authors.lastname: Baxter
authors.affiliation: Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea, United Kingdom; Department of Diabetes & Endocrinology, Morriston Hospital ABM University Health Board, Swansea, United Kingdom; Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital ABM University Health Board, Swansea, United Kingdom.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Stephens
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D015904:Biliopancreatic Diversion / Q000379:methods; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000502:physiology; D002784:Cholesterol / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005749:Gastric Inhibitory Polypeptide / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D054795:Incretins / Q000378:metabolism*; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D010535:Laparoscopy / Q000379:methods*; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D014280:Triglycerides / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D054795:Incretins; D007328:Insulin; D014280:Triglycerides
keywords: Biliopancreatic diversion; Obesity; Sleeve gastrectomy; Type 2 diabetes mellitus