title: Metabolic improvements following Roux-en-Y surgery assessed by solid meal test in subjects with short duration type 2 diabetes.
abstract: BACKGROUND
  Glucose homeostasis improves within days following Roux-en-Y gastric bypass (RYGB) surgery. The dynamic metabolic response to caloric intake following RYGB has been assessed using liquid mixed meal tolerance tests (MMTT). Few studies have evaluated the glycemic and hormonal response to a solid mixed meal in subjects with diabetes prior to, and within the first month following RYGB.
  
  
  METHODS
  Seventeen women with type 2 diabetes of less than 5 years duration participated. Fasting measures of glucose homeostasis, lipids and gut hormones were obtained pre- and post-surgery. MMTT utilizing a solid 4 oz chocolate pudding performed pre-, 2 and 4 weeks post-surgery. Metabolic response to 4 and 2 oz MMTT assessed in five diabetic subjects not undergoing surgery.
  
  
  RESULTS
  Significant reductions in fasting glucose and insulin at 3 days, and in fasting betatrophin, triglycerides and total cholesterol at 2 weeks post-surgery. Hepatic insulin clearance was greater at 3 days post-surgery. Subjects exhibited less hunger and greater feelings of fullness and satisfaction during the MMTT while consuming 52.9 ± 6.5% and 51.0 ± 6.5% of the meal at 2 and 4 weeks post-surgery respectively. At 2 weeks post-surgery, glucose and insulin response to MMTT were improved, with greater GLP-1 and PYY secretion. Improved response to solid MMTT not replicated by consumption of smaller pudding volume in diabetic non-surgical subjects.
  
  
  CONCLUSIONS
  With a test meal of size and composition representative of the routine diet of post-RYGB subjects, improved glycemic and gut hormone responses occur which cannot be replicated by reducing the size of the MMTT in diabetic subjects not undergoing surgery.
  
  
  BACKGROUND
  Clinical Trials.gov Identifier: NCT00957957 August 11, 2009.
authors.affiliation: Experimental Medicine, Merck and Company, Rahway, NJ USA.
authors.forename: Sudha S
authors.initials: SS
authors.lastname: Shankar
authors.affiliation: Experimental Medicine, Merck and Company, Rahway, NJ USA.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Mixson
authors.affiliation: Experimental Medicine, Merck and Company, Rahway, NJ USA.
authors.forename: Manu
authors.initials: M
authors.lastname: Chakravarthy
authors.affiliation: Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Chisholm
authors.affiliation: Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Acton
authors.affiliation: Community Bariatric Services, Indianapolis, IN USA.
authors.forename: RoseMarie
authors.initials: R
authors.lastname: Jones
authors.affiliation: Department of Surgery, Oregon Health & Science University, Portland, OR USA.
authors.forename: Samer G
authors.initials: SG
authors.lastname: Mattar
authors.affiliation: Experimental Medicine, Merck and Company, Rahway, NJ USA.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Miller
authors.affiliation: Experimental Medicine, Merck and Company, Rahway, NJ USA.
authors.forename: Lea
authors.initials: L
authors.lastname: Petry
authors.affiliation: Experimental Medicine, Merck and Company, Rahway, NJ USA.
authors.forename: Chan R
authors.initials: CR
authors.lastname: Beals
authors.affiliation: Experimental Medicine, Merck and Company, Rahway, NJ USA.
authors.forename: S Aubrey
authors.initials: SA
authors.lastname: Stoch
authors.affiliation: Experimental Medicine, Merck and Company, Rahway, NJ USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Kelley
authors.affiliation: Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA.
authors.forename: Robert V
authors.initials: RV
authors.lastname: Considine
keywords: C-peptide; GLP-1; Glucose; Gut hormones; Insulin; Meal test; Roux-en-Y