Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 8/2016

01-08-2016 | Original Contributions

Differential Acute Impacts of Sleeve Gastrectomy, Roux-en-Y Gastric Bypass Surgery and Matched Caloric Restriction Diet on Insulin Secretion, Insulin Effectiveness and Non-Esterified Fatty Acid Levels Among Patients with Type 2 Diabetes

Authors: Felicity Thomas, Greg C. Smith, Jun Lu, Richard Babor, Michael Booth, Grant Beban, J. Geoffrey Chase, Rinki Murphy

Published in: Obesity Surgery | Issue 8/2016

Login to get access

Abstract

Background

Bariatric surgery is an increasingly common option for control of type 2 diabetes (T2D) and obesity. Mechanisms underlying rapid improvement of T2D after different types of bariatric surgery are not clear. Caloric deprivation and altered levels of non-esterified fatty acid (NEFA) have been proposed. This study examines how sleeve gastrectomy (SG), Roux-en-Y gastric bypass (GBP) or matched hypocaloric diet (DT) achieves improvements in T2D by characterising components of the glucose metabolism and NEFA levels before and 3 days after each intervention.

Methods

Plasma samples at five time points during oral glucose tolerance test (OGTT) from subjects with T2D undergoing GBP (N = 11) or SG (N = 12) were analysed for C-peptide, insulin and glucose before surgery and 3-day post-intervention or after DT (N = 5). Fasting palmitic, linoleic, oleic and stearic acid were measured. C-peptide measurements were used to model insulin secretion rate (ISR) using deconvolution.

Results

Subjects who underwent GBP surgery experienced the greatest improvement in glycaemia (median reduction in blood glucose (BG) from basal by 29 % [IQR −57, −18]) and the greatest reduction in all NEFA measured. SG achieved improvement in glycaemia with lower ISR and reduction in all but palmitoleic acid. DT subjects achieved improvement in glycaemia with an increase in ISR, 105 % [IQR, 20, 220] and stearic acid.

Conclusions

GBP, SG and DT each improve glucose metabolism through different effects on pancreatic beta cell function, insulin sensitivity and free fatty acids.
Literature
1.
2.
Buchwald H et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–U81.CrossRefPubMed
3.
Pories WJ et al. Who would have thought it—an operation proves to be the most effective therapy for adult-onset diabetes-mellitus. Ann Surg. 1995;222(3):339–52.CrossRefPubMedPubMedCentral
4.
Isbell JM et al. The importance of caloric restriction in the early improvements in insulin sensitivity after Roux-en-Y gastric bypass surgery. Diabetes Care. 2010;33(7):1438–42.CrossRefPubMedPubMedCentral
5.
Kashyap SR et al. Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes. Int J Obes. 2010;34(3):462–71.CrossRef
6.
Bayham BE et al. Early resolution of type 2 diabetes seen after Roux-en-Y gastric bypass and vertical sleeve gastrectomy. Diabetes Technol Ther. 2012;14(1):30–4.CrossRefPubMed
7.
Ramon JM et al. Effect of Roux-en-Y gastric bypass vs sleeve gastrectomy on glucose and gut hormones: a prospective randomised trial. J Gastrointest Surg. 2012;16(6):1116–22.CrossRefPubMed
8.
Henry RR, Scheaffer L, Olefsky JM. Glycemic effects of intensive caloric restriction and isocaloric refeeding in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab. 1985;61(5):917–25.CrossRefPubMed
9.
Lim EL et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54(10):2506–14.CrossRefPubMedPubMedCentral
10.
Salinari S et al. Twenty-four hour insulin secretion and beta cell NEFA oxidation in type 2 diabetic, morbidly obese patients before and after bariatric surgery. Diabetologia. 2008;51(7):1276–84.CrossRefPubMed
11.
Reaven GM et al. Measurement of plasma-glucose, free fatty-acid, lactate, and insulin for 24-H in patients with NIDDM. Diabetes. 1988;37(8):1020–4.CrossRefPubMed
12.
Yue KT et al. Effect of glucose on plasma concentrations of individual non-esterified fatty acids of non-diabetic and insulin-independent diabetic men. Postgrad Med J. 1981;57(672):622–6.CrossRefPubMedPubMedCentral
13.
14.
Unger RH. Lipotoxicity in the pathogenesis of obesity-dependent NIDDM—genetic and clinical implications. Diabetes. 1995;44(8):863–70.CrossRefPubMed
15.
McGarry JD, Dobbins RL. Fatty acids, lipotoxicity and insulin secretion. Diabetologia. 1999;42(2):128–38.CrossRefPubMed
16.
Sako Y, Grill VE. A 48-hour lipid infusion in the rat time-dependently inhibits glucose-induced insulin-secretion and B-cell oxidation through a process likely coupled to fatty-acid oxidation. Endocrinology. 1990;127(4):1580–9.CrossRefPubMed
17.
Boden G. Role of fatty acids in the pathogenesis of insulin resistance and NIDDM. Diabetes. 1997;46(1):3–10.CrossRefPubMed
18.
19.
Yip S, Plank LD, Murphy R. Gastric bypass and sleeve gastrectomy for type 2 diabetes: a systematic review and meta-analysis of outcomes. Obes Surg. 2013;23(12):1994–2003.CrossRefPubMed
20.
Bierman EL, Schwartz IL, Dole VP. Action of insulin on release of fatty acids from tissue stores. Am J Physiol. 1957;191(2):359–62.PubMed
21.
Hirsch J, Goldrick RB. Serial studies on the metabolism of human adipose tissue. I. Lipogenesis and free fatty acid uptake and release in small aspirated samples of subcutaneous fat. J Clin Invest. 1964;43:1776–92.CrossRefPubMedPubMedCentral
22.
Gray DS et al. Changes in individual plasma free fatty acids in obese females during fasting and refeeding. Int J Obes. 1991;15(2):163–8.PubMed
23.
Van Cauter E et al. Estimation of insulin secretion rates from C-peptide levels. Comparison of individual and standard kinetic parameters for C-peptide clearance. Diabetes. 1992;41(3):368–77.CrossRefPubMed
24.
Lee WJ et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146(2):143–8.CrossRefPubMed
25.
26.
Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care. 2002;25(2):358–63.CrossRefPubMed
27.
Ballantyne GH et al. Short-term changes in insulin resistance following weight loss surgery for morbid obesity: laparoscopic adjustable gastric banding versus laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2006;16(9):1189–97.CrossRefPubMed
28.
Camastra S et al. Beta-cell function in severely obese type 2 diabetic patients: long-term effects of bariatric surgery. Diabetes Care. 2007;30(4):1002–4.CrossRefPubMed
29.
Mari A et al. Restoration of normal glucose tolerance in severely obese patients after bilio-pancreatic diversion: role of insulin sensitivity and beta cell function. Diabetologia. 2006;49(9):2136–43.CrossRefPubMed
30.
Ferrannini E, Mingrone G. Impact of different bariatric surgical procedures on insulin action and beta-cell function in type 2 diabetes. Diabetes Care. 2009;32(3):514–20.CrossRefPubMedPubMedCentral
31.
Yip S et al. Lower glycemic fluctuations early after bariatric surgery partially explained by caloric restriction. Obes Surg. 2014;24(1):62–70.CrossRefPubMed
Metadata
Title
Differential Acute Impacts of Sleeve Gastrectomy, Roux-en-Y Gastric Bypass Surgery and Matched Caloric Restriction Diet on Insulin Secretion, Insulin Effectiveness and Non-Esterified Fatty Acid Levels Among Patients with Type 2 Diabetes
Authors
Felicity Thomas
Greg C. Smith
Jun Lu
Richard Babor
Michael Booth
Grant Beban
J. Geoffrey Chase
Rinki Murphy
Publication date
01-08-2016
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2016
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-2038-3

Other articles of this Issue 8/2016

Obesity Surgery 8/2016 Go to the issue

Letter to Editor/LED Reply

Reply for the Letter to the Editor for the Manuscript “Sleeve Gastrectomy and Roux-y-Gastric Bypass Lead to Comparable Changes in Body Composition After Adjustment for Initial Body Mass Index”

Original Contributions

Improvements of Glucose and Lipid Metabolism After Jejuno-ileal Circuit Procedure in a Non-obese Diabetic Rat Model

Original Contributions

Bariatric Surgery Among Obese Veterans: a Retrospective Review of Complications and Intermediate Term Results from a Single Institution

Original Contributions

Impact of Pregnancy on Weight Loss and Quality of Life Following Gastric Banding

Original Contributions

The Effects of Sleeve Gastrectomy and Gastric Bypass on Branched-Chain Amino Acid Metabolism 1 Year After Bariatric Surgery

Letter to the Editor

Objective Non-irradiant Imaging of Fat Distribution: New Essential Tools for the Bariatric Surgery?