title: Short- and long-term hormonal and metabolic consequences of reversing gastric bypass to normal anatomy in a type 2 diabetes patient.
abstract: Gastric bypass (GBP) results in rapid type 2 diabetes (T2D) remission in most cases. Consequences of GBP reversal are unknown. A GBP-operated T2D patient was given mixed-meal tests before (MMTpre), 2 months (MMT2-M) and 12 months (MMT12-M) after GBP reversal. Glucose, hormones and metabolite profiles were assessed. MMT2-M displayed slightly lower glucose levels; MMT12-M displayed higher glucose and insulin levels, indicating deteriorating glycaemia. Homeostasis model assessment (HOMA)-β was higher at MMT2-M, but reduced at MMT12-M. Matsuda index revealed slightly reduced insulin sensitivity at MMT2-M, which deteriorated further at MMT12-M. Markers for metabolic stress and insulin resistance were elevated at MMT12-M. Gastric inhibitory polypeptide (GIP) levels were increased at MMT2-M and decreased at MMT12-M. Glucagon-like peptide-1 (GLP-1) decreased at MMT2-M and further decreased at MMT12-M. In conclusion, in this patient, GBP reversal provoked deteriorating glycaemia and long-term development of insulin resistance.
authors.affiliation: Clinical Research Centre, Neuroendocrine Cell Biology, Department of Clinical Sciences in Malmö, Lund University Diabetes Centre, Skåne University Hospital, Jan Waldenströms gata 35, Malmö, Sweden, nils.wierup@med.lu.se.
authors.forename: Nils
authors.initials: N
authors.lastname: Wierup
authors.forename: Andreas
authors.initials: A
authors.lastname: Lindqvist
authors.forename: Peter
authors.initials: P
authors.lastname: Spégel
authors.forename: Leif
authors.initials: L
authors.lastname: Groop
authors.forename: Jan
authors.initials: J
authors.lastname: Hedenbro
authors.forename: Mikael
authors.initials: M
authors.lastname: Ekelund
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000601:surgery*; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000534:rehabilitation; D005749:Gastric Inhibitory Polypeptide / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D062407:Meals; D008875:Middle Aged; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007328:Insulin; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1