title: FGF 19 and Bile Acids Increase Following Roux-en-Y Gastric Bypass but Not After Medical Management in Patients with Type 2 Diabetes.
abstract: BACKGROUND
  This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment.
  
  
  METHODS
  Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n = 15) or RYGB (n = 15).
  
  
  RESULTS
  Mean HbA1c decreased from 9.7 to 6.4% after RYGB and from 9.1 to 6.1% in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5 ± 0.5) was less than in the IMM group (4.6 ± 0.3). After RYGB, FGF19 increased in the fasted (93 ± 15 to 152 ± 19 pg/ml; P = 0.008) and postprandial states (area under the curve (AUC), 10.8 ± 1.9 to 23.4 ± 4.1 pg × h/ml × 10(3); P = 0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×10(3), 6.63 ± 1.3 to 15.16 ± 2.56 μM × h; P = 0.003) and decreased after IMM (AUC ×10(3), 8.22 ± 1.24 to 5.70 ± 0.70; P = 0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r = 0.54, P = 0.04) and trended negatively with HbA1c (r = -0.44; P = 0.09); these associations were not observed after IMM.
  
  
  CONCLUSIONS
  BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.
authors.affiliation: Department of Medicine, Columbia University Medical Center, 650 West 168th St, Black Building, Room 905, New York, NY, 10032, USA.
authors.forename: Saachi
authors.initials: S
authors.lastname: Sachdev
authors.affiliation: Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Billington
authors.affiliation: Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA.
authors.forename: John
authors.initials: J
authors.lastname: Connett
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Leaque
authors.initials: L
authors.lastname: Ahmed
authors.affiliation: Department of Surgery, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Inabnet
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Streamson
authors.initials: S
authors.lastname: Chua
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Sayeed
authors.initials: S
authors.lastname: Ikramuddin
authors.affiliation: Department of Medicine, Columbia University Medical Center, 650 West 168th St, Black Building, Room 905, New York, NY, 10032, USA. jk181@columbia.edu.
authors.forename: Judith
authors.initials: J
authors.lastname: Korner
mesh_terms: D000328:Adult; D001647:Bile Acids and Salts / Q000097:blood*; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D005215:Fasting / Q000097:blood; D005260:Female; D005346:Fibroblast Growth Factors / Q000097:blood*; D015390:Gastric Bypass; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood* / Q000150:complications / Q000601:surgery; D019518:Postprandial Period; D016896:Treatment Outcome
chemical_list: D001647:Bile Acids and Salts; D001786:Blood Glucose; C117476:FGF19 protein, human; D007004:Hypoglycemic Agents; D005346:Fibroblast Growth Factors
keywords: Bile acids; Fibroblast growth factor 19; Glucagon-like peptide-1; Roux-en-Y gastric bypass; Type 2 diabetes mellitus