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Published in: Current Atherosclerosis Reports 10/2013

01-10-2013 | Lipid and Metabolic Effects of Gastrointestinal Surgery (F Rubino, Section Editor)

Diabetes Remission Following Metabolic Surgery: Is GLP-1 the Culprit?

Authors: Josep Vidal, Amanda Jiménez

Published in: Current Atherosclerosis Reports | Issue 10/2013

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Abstract

The parallel occurrence of improved glucose tolerance and increased glucagon-like peptide 1 (GLP-1) response to meal intake following metabolic surgery (MS) demonstrated in several studies has led to the notion that GLP-1 is the culprit for the impressive rates of remission of type 2 diabetes mellitus (T2DM) following MS. In this article, we critically review current evidence supporting this view. Recent studies specifically designed to elucidate a causative role of GLP-1 in the antidiabetic effects of MS call into question GLP-1 as a key player for T2DM outcome following MS procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese subjects. Whether GLP-1 plays a more prominent role in the remission of T2DM following MS in subjects with moderate obesity warrants further studies. Appraisal of the mechanisms involved in the amelioration of hyperglycemia following MS is a priority, as it could help in the battle against the current combined epidemics of obesity and T2DM.
Literature
1.
go back to reference Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76.PubMedCrossRef Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76.PubMedCrossRef
2.
go back to reference Mingrone G, Panunzi S, De GA, Guidone C, Iaconelli A, Leccesi L, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577–85.PubMedCrossRef Mingrone G, Panunzi S, De GA, Guidone C, Iaconelli A, Leccesi L, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577–85.PubMedCrossRef
3.
go back to reference • Ikramuddin S, Korner J, Lee WJ, Connett JE, Inabnet WB, Billington CJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309:2240–9. This is a randomized clinical trial showing superiority of RYGB over medical therapy, as well as the importance of weight loss, in the metabolic control of subjects with T2DM and BMI between 30 and 40 kg/m 2 .PubMedCrossRef • Ikramuddin S, Korner J, Lee WJ, Connett JE, Inabnet WB, Billington CJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309:2240–9. This is a randomized clinical trial showing superiority of RYGB over medical therapy, as well as the importance of weight loss, in the metabolic control of subjects with T2DM and BMI between 30 and 40 kg/m 2 .PubMedCrossRef
4.
go back to reference Demaria EJ, Winegar DA, Pate VW, Hutcher NE, Ponce J, Pories WJ. Early postoperative outcomes of metabolic surgery to treat diabetes from sites participating in the ASMBS Bariatric Surgery Center of Excellence program as reported in the Bariatric Outcomes Longitudinal Database. Ann Surg. 2010;252:559–66.PubMed Demaria EJ, Winegar DA, Pate VW, Hutcher NE, Ponce J, Pories WJ. Early postoperative outcomes of metabolic surgery to treat diabetes from sites participating in the ASMBS Bariatric Surgery Center of Excellence program as reported in the Bariatric Outcomes Longitudinal Database. Ann Surg. 2010;252:559–66.PubMed
5.
go back to reference Pournaras DJ, Osborne A, Hawkins SC, Vincent RP, Mahon D, Ewings P, et al. Remission of type 2 diabetes after gastric bypass and banding: mechanisms and 2 year outcomes. Ann Surg. 2010;252:966–71.PubMedCrossRef Pournaras DJ, Osborne A, Hawkins SC, Vincent RP, Mahon D, Ewings P, et al. Remission of type 2 diabetes after gastric bypass and banding: mechanisms and 2 year outcomes. Ann Surg. 2010;252:966–71.PubMedCrossRef
6.
go back to reference • Dirksen C, Jorgensen NB, Bojsen-Moller KN, Jacobsen SH, Hansen DL, Worm D, et al. Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass. Diabetologia. 2012;55:1890–901. This is an in-depth discussion of current views on the mechanisms of improved glucose tolerance following MS.PubMedCrossRef • Dirksen C, Jorgensen NB, Bojsen-Moller KN, Jacobsen SH, Hansen DL, Worm D, et al. Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass. Diabetologia. 2012;55:1890–901. This is an in-depth discussion of current views on the mechanisms of improved glucose tolerance following MS.PubMedCrossRef
7.
8.
go back to reference Muscelli E, Mari A, Casolaro A, Camastra S, Seghieri G, Gastaldelli A, et al. Separate impact of obesity and glucose tolerance on the incretin effect in normal subjects and type 2 diabetic patients. Diabetes. 2008;57:1340–8.PubMedCrossRef Muscelli E, Mari A, Casolaro A, Camastra S, Seghieri G, Gastaldelli A, et al. Separate impact of obesity and glucose tolerance on the incretin effect in normal subjects and type 2 diabetic patients. Diabetes. 2008;57:1340–8.PubMedCrossRef
9.
go back to reference Knop FK, Aaboe K, Vilsboll T, Volund A, Holst JJ, Krarup T, et al. Impaired incretin effect and fasting hyperglucagonaemia characterizing type 2 diabetic subjects are early signs of dysmetabolism in obesity. Diabetes Obes Metab. 2012;14:500–10.PubMedCrossRef Knop FK, Aaboe K, Vilsboll T, Volund A, Holst JJ, Krarup T, et al. Impaired incretin effect and fasting hyperglucagonaemia characterizing type 2 diabetic subjects are early signs of dysmetabolism in obesity. Diabetes Obes Metab. 2012;14:500–10.PubMedCrossRef
10.
go back to reference Madsbad S, Krarup T, Deacon CF, Holst JJ. Glucagon-like peptide receptor agonists and dipeptidyl peptidase-4 inhibitors in the treatment of diabetes: a review of clinical trials. Curr Opin Clin Nutr Metab Care. 2008;11:491–9.PubMedCrossRef Madsbad S, Krarup T, Deacon CF, Holst JJ. Glucagon-like peptide receptor agonists and dipeptidyl peptidase-4 inhibitors in the treatment of diabetes: a review of clinical trials. Curr Opin Clin Nutr Metab Care. 2008;11:491–9.PubMedCrossRef
11.
go back to reference Laferrere B, Heshka S, Wang K, Khan Y, McGinty J, Teixeira J, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care. 2007;30:1709–16.PubMedCrossRef Laferrere B, Heshka S, Wang K, Khan Y, McGinty J, Teixeira J, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care. 2007;30:1709–16.PubMedCrossRef
12.
go back to reference Laferrere B, Teixeira J, McGinty J, Tran H, Egger JR, Colarusso A, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93:2479–85.PubMedCrossRef Laferrere B, Teixeira J, McGinty J, Tran H, Egger JR, Colarusso A, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93:2479–85.PubMedCrossRef
13.
go back to reference Morinigo R, Moize V, Musri M, Lacy AM, Navarro S, Marin JL, et al. Glucagon-like peptide-1, peptide YY, hunger, and satiety after gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2006;91:1735–40.PubMedCrossRef Morinigo R, Moize V, Musri M, Lacy AM, Navarro S, Marin JL, et al. Glucagon-like peptide-1, peptide YY, hunger, and satiety after gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2006;91:1735–40.PubMedCrossRef
14.
go back to reference Falken Y, Hellstrom PM, Holst JJ, Naslund E. Changes in glucose homeostasis after Roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery: role of gut peptides. J Clin Endocrinol Metab. 2011;96:2227–35.PubMedCrossRef Falken Y, Hellstrom PM, Holst JJ, Naslund E. Changes in glucose homeostasis after Roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery: role of gut peptides. J Clin Endocrinol Metab. 2011;96:2227–35.PubMedCrossRef
15.
go back to reference Dirksen C, Hansen DL, Madsbad S, Hvolris LE, Naver LS, Holst JJ, et al. Postprandial diabetic glucose tolerance is normalized by gastric bypass feeding as opposed to gastric feeding and is associated with exaggerated GLP-1 secretion: a case report. Diabetes Care. 2010;33:375–7.PubMedCrossRef Dirksen C, Hansen DL, Madsbad S, Hvolris LE, Naver LS, Holst JJ, et al. Postprandial diabetic glucose tolerance is normalized by gastric bypass feeding as opposed to gastric feeding and is associated with exaggerated GLP-1 secretion: a case report. Diabetes Care. 2010;33:375–7.PubMedCrossRef
16.
go back to reference Romero F, Nicolau J, Flores L, Casamitjana R, Ibarzabal A, Lacy A, et al. Comparable early changes in gastrointestinal hormones after sleeve gastrectomy and Roux-en-Y gastric bypass surgery for morbidly obese type 2 diabetic subjects. Surg Endosc. 2012;26:2231–9.PubMedCrossRef Romero F, Nicolau J, Flores L, Casamitjana R, Ibarzabal A, Lacy A, et al. Comparable early changes in gastrointestinal hormones after sleeve gastrectomy and Roux-en-Y gastric bypass surgery for morbidly obese type 2 diabetic subjects. Surg Endosc. 2012;26:2231–9.PubMedCrossRef
17.
go back to reference • Salehi M, Prigeon RL, D'Alessio DA. Gastric bypass surgery enhances glucagon-like peptide 1-stimulated postprandial insulin secretion in humans. Diabetes. 2011;60:2308–14. This is an elegant demonstration, using the hyperglycemic clamp approach, of the relevance of GLP-1 in insulin secretion following RYGB. The study design is not well suited to address the relevance of GLP-1 in glucose tolerance. Of note, the authors failed to show a larger contribution of GLP-1 to insulin secretion in those with postprandial hypoglycemia after this type of surgery.PubMedCrossRef • Salehi M, Prigeon RL, D'Alessio DA. Gastric bypass surgery enhances glucagon-like peptide 1-stimulated postprandial insulin secretion in humans. Diabetes. 2011;60:2308–14. This is an elegant demonstration, using the hyperglycemic clamp approach, of the relevance of GLP-1 in insulin secretion following RYGB. The study design is not well suited to address the relevance of GLP-1 in glucose tolerance. Of note, the authors failed to show a larger contribution of GLP-1 to insulin secretion in those with postprandial hypoglycemia after this type of surgery.PubMedCrossRef
18.
go back to reference Dar MS, Chapman III WH, Pender JR, Drake III AJ, O'Brien K, Tanenberg RJ, et al. GLP-1 response to a mixed meal: what happens 10 years after Roux-en-Y gastric bypass (RYGB)? Obes Surg. 2012;22:1077–83.PubMedCrossRef Dar MS, Chapman III WH, Pender JR, Drake III AJ, O'Brien K, Tanenberg RJ, et al. GLP-1 response to a mixed meal: what happens 10 years after Roux-en-Y gastric bypass (RYGB)? Obes Surg. 2012;22:1077–83.PubMedCrossRef
19.
go back to reference McLaughlin T, Peck M, Holst J, Deacon C. Reversible hyperinsulinemic hypoglycemia after gastric bypass: a consequence of altered nutrient delivery. J Clin Endocrinol Metab. 2010;95:1851–5.PubMedCrossRef McLaughlin T, Peck M, Holst J, Deacon C. Reversible hyperinsulinemic hypoglycemia after gastric bypass: a consequence of altered nutrient delivery. J Clin Endocrinol Metab. 2010;95:1851–5.PubMedCrossRef
20.
go back to reference Dirksen C, Damgaard M, Bojsen-Moller KN, Jorgensen NB, Kielgast U, Jacobsen SH, et al. Fast pouch emptying, delayed small intestinal transit, and exaggerated gut hormone responses after Roux-en-Y gastric bypass. Neurogastroenterol Motil. 2013;25:346–e255.PubMedCrossRef Dirksen C, Damgaard M, Bojsen-Moller KN, Jorgensen NB, Kielgast U, Jacobsen SH, et al. Fast pouch emptying, delayed small intestinal transit, and exaggerated gut hormone responses after Roux-en-Y gastric bypass. Neurogastroenterol Motil. 2013;25:346–e255.PubMedCrossRef
21.
go back to reference Peterli R, Wolnerhanssen B, Peters T, Devaux N, Kern B, Christoffel-Courtin C, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250:234–41.PubMedCrossRef Peterli R, Wolnerhanssen B, Peters T, Devaux N, Kern B, Christoffel-Courtin C, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250:234–41.PubMedCrossRef
22.
go back to reference Jimenez A, Casamitjana R, Flores L, Viaplana J, Corcelles R, Lacy A, et al. Long-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012;256:1023–9.PubMedCrossRef Jimenez A, Casamitjana R, Flores L, Viaplana J, Corcelles R, Lacy A, et al. Long-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012;256:1023–9.PubMedCrossRef
23.
go back to reference Valderas JP, Irribarra V, Rubio L, Boza C, Escalona M, Liberona Y, et al. Effects of sleeve gastrectomy and medical treatment for obesity on glucagon-like peptide 1 levels and glucose homeostasis in non-diabetic subjects. Obes Surg. 2011;21:902–9.PubMedCrossRef Valderas JP, Irribarra V, Rubio L, Boza C, Escalona M, Liberona Y, et al. Effects of sleeve gastrectomy and medical treatment for obesity on glucagon-like peptide 1 levels and glucose homeostasis in non-diabetic subjects. Obes Surg. 2011;21:902–9.PubMedCrossRef
24.
go back to reference Gill RS, Birch DW, Shi X, Sharma AM, Karmali S. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis. 2010;6:707–13.PubMedCrossRef Gill RS, Birch DW, Shi X, Sharma AM, Karmali S. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis. 2010;6:707–13.PubMedCrossRef
25.
26.
go back to reference Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–84.PubMed Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–84.PubMed
27.
go back to reference Hamza N, Abbas MH, Darwish A, Shafeek Z, New J, Ammori BJ. Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass. Surg Obes Relat Dis. 2011;7:691–6.PubMedCrossRef Hamza N, Abbas MH, Darwish A, Shafeek Z, New J, Ammori BJ. Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass. Surg Obes Relat Dis. 2011;7:691–6.PubMedCrossRef
28.
go back to reference Chikunguwo SM, Wolfe LG, Dodson P, Meador JG, Baugh N, Clore JN, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6:254–9.PubMedCrossRef Chikunguwo SM, Wolfe LG, Dodson P, Meador JG, Baugh N, Clore JN, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6:254–9.PubMedCrossRef
29.
go back to reference DiGiorgi M, Rosen DJ, Choi JJ, Milone L, Schrope B, Olivero-Rivera L, et al. Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. Surg Obes Relat Dis. 2010;6:249–53.PubMedCrossRef DiGiorgi M, Rosen DJ, Choi JJ, Milone L, Schrope B, Olivero-Rivera L, et al. Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. Surg Obes Relat Dis. 2010;6:249–53.PubMedCrossRef
30.
go back to reference Jimenez A, Casamitjana R, Flores L, Delgado S, Lacy A, Vidal J. GLP-1 and the long-term outcome of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery in morbidly obese subjects. Ann Surg. 2013;257:894–9.PubMedCrossRef Jimenez A, Casamitjana R, Flores L, Delgado S, Lacy A, Vidal J. GLP-1 and the long-term outcome of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery in morbidly obese subjects. Ann Surg. 2013;257:894–9.PubMedCrossRef
31.
go back to reference Nannipieri M, Mari A, Anselmino M, Baldi S, Barsotti E, Guarino D, et al. The role of beta-cell function and insulin sensitivity in the remission of type 2 diabetes after gastric bypass surgery. J Clin Endocrinol Metab. 2011;96:E1372–9.PubMedCrossRef Nannipieri M, Mari A, Anselmino M, Baldi S, Barsotti E, Guarino D, et al. The role of beta-cell function and insulin sensitivity in the remission of type 2 diabetes after gastric bypass surgery. J Clin Endocrinol Metab. 2011;96:E1372–9.PubMedCrossRef
32.
go back to reference Rodieux F, Giusti V, D'Alessio DA, Suter M, Tappy L. Effects of gastric bypass and gastric banding on glucose kinetics and gut hormone release. Obesity (Silver Spring). 2008;16:298–305.CrossRef Rodieux F, Giusti V, D'Alessio DA, Suter M, Tappy L. Effects of gastric bypass and gastric banding on glucose kinetics and gut hormone release. Obesity (Silver Spring). 2008;16:298–305.CrossRef
33.
go back to reference • Bradley D, Conte C, Mittendorfer B, Eagon JC, Varela JE, Fabbrini E, et al. Gastric bypass and banding equally improve insulin sensitivity and beta cell function. J Clin Invest. 2012;122:4667–74. This is an in-depth discussion of the changes in the determinants of glucose homeostasis following RYGB and AGB when participants had achieved major weight loss (20% relative to the baseline). No differences were found between the different types of surgery despite major differences in the modification of gut anatomy associated with each type of surgery.PubMedCrossRef • Bradley D, Conte C, Mittendorfer B, Eagon JC, Varela JE, Fabbrini E, et al. Gastric bypass and banding equally improve insulin sensitivity and beta cell function. J Clin Invest. 2012;122:4667–74. This is an in-depth discussion of the changes in the determinants of glucose homeostasis following RYGB and AGB when participants had achieved major weight loss (20% relative to the baseline). No differences were found between the different types of surgery despite major differences in the modification of gut anatomy associated with each type of surgery.PubMedCrossRef
34.
go back to reference Salinari S, Carr RD, Guidone C, Bertuzzi A, Cercone S, Riccioni ME, et al. Nutrient infusion bypassing duodenum - jejunum reverses insulin resistance in normotolerant and diabetic obese subjects. Am J Physiol Endocrinol Metab. 2013. doi:10.1152/ajpendo.00559.2012.PubMed Salinari S, Carr RD, Guidone C, Bertuzzi A, Cercone S, Riccioni ME, et al. Nutrient infusion bypassing duodenum - jejunum reverses insulin resistance in normotolerant and diabetic obese subjects. Am J Physiol Endocrinol Metab. 2013. doi:10.​1152/​ajpendo.​00559.​2012.PubMed
35.
go back to reference Deane AM, Nguyen NQ, Stevens JE, Fraser RJ, Holloway RH, Besanko LK, et al. Endogenous glucagon-like peptide-1 slows gastric emptying in healthy subjects, attenuating postprandial glycemia. J Clin Endocrinol Metab. 2010;95:215–21.PubMedCrossRef Deane AM, Nguyen NQ, Stevens JE, Fraser RJ, Holloway RH, Besanko LK, et al. Endogenous glucagon-like peptide-1 slows gastric emptying in healthy subjects, attenuating postprandial glycemia. J Clin Endocrinol Metab. 2010;95:215–21.PubMedCrossRef
36.
go back to reference Nicolaus M, Brodl J, Linke R, Woerle HJ, Goke B, Schirra J. Endogenous GLP-1 regulates postprandial glycemia in humans: relative contributions of insulin, glucagon, and gastric emptying. J Clin Endocrinol Metab. 2011;96:229–36.PubMedCrossRef Nicolaus M, Brodl J, Linke R, Woerle HJ, Goke B, Schirra J. Endogenous GLP-1 regulates postprandial glycemia in humans: relative contributions of insulin, glucagon, and gastric emptying. J Clin Endocrinol Metab. 2011;96:229–36.PubMedCrossRef
37.
go back to reference Salehi M, Aulinger B, Prigeon RL, D'Alessio DA. Effect of endogenous GLP-1 on insulin secretion in type 2 diabetes. Diabetes. 2010;59:1330–7.PubMedCrossRef Salehi M, Aulinger B, Prigeon RL, D'Alessio DA. Effect of endogenous GLP-1 on insulin secretion in type 2 diabetes. Diabetes. 2010;59:1330–7.PubMedCrossRef
38.
go back to reference Woerle HJ, Carneiro L, Derani A, Goke B, Schirra J. The role of endogenous incretin secretion as amplifier of glucose-stimulated insulin secretion in healthy subjects and patients with type 2 diabetes. Diabetes. 2012;61:2349–58.PubMedCrossRef Woerle HJ, Carneiro L, Derani A, Goke B, Schirra J. The role of endogenous incretin secretion as amplifier of glucose-stimulated insulin secretion in healthy subjects and patients with type 2 diabetes. Diabetes. 2012;61:2349–58.PubMedCrossRef
39.
go back to reference •• Jorgensen NB, Dirksen C, Bojsen-Moller KN, Jacobsen SH, Worm D, Hansen DL, et al. The exaggerated glucagon-like peptide-1 response is important for the improved beta-cell function and glucose tolerance after Roux-en-Y gastric bypass in patients with type 2 diabetes. Diabetes. 2013. doi:10.2337/db13-0022. This is a prospective study evaluating the impact of the blockade of the action of GLP-1 by the action of exendin (9-39) on glucose tolerance and insulin secretion in the short term after RYGB. The study supports an important role of GLP-1 in improved glucose tolerance at a time after surgery when no major weight loss has occurred. •• Jorgensen NB, Dirksen C, Bojsen-Moller KN, Jacobsen SH, Worm D, Hansen DL, et al. The exaggerated glucagon-like peptide-1 response is important for the improved beta-cell function and glucose tolerance after Roux-en-Y gastric bypass in patients with type 2 diabetes. Diabetes. 2013. doi:10.​2337/​db13-0022. This is a prospective study evaluating the impact of the blockade of the action of GLP-1 by the action of exendin (9-39) on glucose tolerance and insulin secretion in the short term after RYGB. The study supports an important role of GLP-1 in improved glucose tolerance at a time after surgery when no major weight loss has occurred.
40.
go back to reference •• Jimenez A, Casamitjana R, Viaplana-Masclans J, Lacy A, Vidal J. GLP-1 action and glucose tolerance in subjects with remission of type 2 diabetes mellitus after gastric bypass surgery. Diabetes Care. 2013. doi:10.2337/dc12-1535. This is a cross-sectional study evaluating the impact of the blockade of the action of GLP-1 by the action of exendin (9-39) on glucose tolerance and insulin secretion in the long term after RYGB. The study supports weight loss rather than GLP-1 as being relevant for improved glucose homeostasis after surgery.PubMed •• Jimenez A, Casamitjana R, Viaplana-Masclans J, Lacy A, Vidal J. GLP-1 action and glucose tolerance in subjects with remission of type 2 diabetes mellitus after gastric bypass surgery. Diabetes Care. 2013. doi:10.​2337/​dc12-1535. This is a cross-sectional study evaluating the impact of the blockade of the action of GLP-1 by the action of exendin (9-39) on glucose tolerance and insulin secretion in the long term after RYGB. The study supports weight loss rather than GLP-1 as being relevant for improved glucose homeostasis after surgery.PubMed
41.
go back to reference •• Wilson-Perez HE, Chambers AP, Ryan KK, Li B, Sandoval DA, Stoffers D, et al. Vertical sleeve gastrectomy is effective in two genetic mouse models of glucagon-like peptide-1 receptor deficiency. Diabetes. 2013. doi:10.2337/db12-1498. This is an experimental study in rodents showing the glucose tolerance and weight loss effects associated with vertical SG in rodents are totally independent of the GLP-1 receptor.PubMed •• Wilson-Perez HE, Chambers AP, Ryan KK, Li B, Sandoval DA, Stoffers D, et al. Vertical sleeve gastrectomy is effective in two genetic mouse models of glucagon-like peptide-1 receptor deficiency. Diabetes. 2013. doi:10.​2337/​db12-1498. This is an experimental study in rodents showing the glucose tolerance and weight loss effects associated with vertical SG in rodents are totally independent of the GLP-1 receptor.PubMed
42.
go back to reference Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444:840–6.PubMedCrossRef Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444:840–6.PubMedCrossRef
43.
go back to reference Kindel TL, Yoder SM, Seeley RJ, D'Alessio DA, Tso P. Duodenal-jejunal exclusion improves glucose tolerance in the diabetic, Goto-Kakizaki rat by a GLP-1 receptor-mediated mechanism. J Gastrointest Surg. 2009;13:1762–72.PubMedCrossRef Kindel TL, Yoder SM, Seeley RJ, D'Alessio DA, Tso P. Duodenal-jejunal exclusion improves glucose tolerance in the diabetic, Goto-Kakizaki rat by a GLP-1 receptor-mediated mechanism. J Gastrointest Surg. 2009;13:1762–72.PubMedCrossRef
44.
go back to reference Gaitonde S, Kohli R, Seeley R. The role of the gut hormone GLP-1 in the metabolic improvements caused by ileal transposition. J Surg Res. 2012;178:33–9.PubMedCrossRef Gaitonde S, Kohli R, Seeley R. The role of the gut hormone GLP-1 in the metabolic improvements caused by ileal transposition. J Surg Res. 2012;178:33–9.PubMedCrossRef
45.
go back to reference Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care. 2012;35:1420–8.PubMedCrossRef Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care. 2012;35:1420–8.PubMedCrossRef
46.
go back to reference Kota SK, Ugale S, Gupta N, Modi KD. Laparoscopic ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes. Diabetes Metab Syndr. 2012;6:125–31.PubMedCrossRef Kota SK, Ugale S, Gupta N, Modi KD. Laparoscopic ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes. Diabetes Metab Syndr. 2012;6:125–31.PubMedCrossRef
47.
go back to reference le Roux CW, Welbourn R, Werling M, Osborne A, Kokkinos A, Laurenius A, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246:780–5.PubMedCrossRef le Roux CW, Welbourn R, Werling M, Osborne A, Kokkinos A, Laurenius A, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246:780–5.PubMedCrossRef
48.
go back to reference Dirksen C, Jorgensen NB, Bojsen-Moller KN, Kielgast U, Jacobsen SH, Clausen TR, et al. Gut hormones, early dumping and resting energy expenditure in patients with good and poor weight loss response after Roux-en-Y gastric bypass. Int J Obes (Lond). 2013. doi:10.1038/ijo.2013.15. Dirksen C, Jorgensen NB, Bojsen-Moller KN, Kielgast U, Jacobsen SH, Clausen TR, et al. Gut hormones, early dumping and resting energy expenditure in patients with good and poor weight loss response after Roux-en-Y gastric bypass. Int J Obes (Lond). 2013. doi:10.​1038/​ijo.​2013.​15.
49.
go back to reference Abegg K, Schiesser M, Lutz TA, Bueter M. Acute peripheral GLP-1 receptor agonism or antagonism does not alter energy expenditure in rats after Roux-en-Y gastric bypass. Physiol Behav. 2013. doi:10.1016/j.physbeh.2013.03.027. Abegg K, Schiesser M, Lutz TA, Bueter M. Acute peripheral GLP-1 receptor agonism or antagonism does not alter energy expenditure in rats after Roux-en-Y gastric bypass. Physiol Behav. 2013. doi:10.​1016/​j.​physbeh.​2013.​03.​027.
50.
go back to reference Sandoval D. Bariatric surgeries: beyond restriction and malabsorption. Int J Obes (Lond). 2011;35 Suppl 3:S45–9.CrossRef Sandoval D. Bariatric surgeries: beyond restriction and malabsorption. Int J Obes (Lond). 2011;35 Suppl 3:S45–9.CrossRef
51.
go back to reference Saeidi N, Meoli L, Nestoridi E, Gupta NK, Kvas S, Kucharczyk J, et al. Reprogramming of intestinal glucose metabolism and glycemic control in rats after gastric bypass. Science. 2013;341:406–10.PubMedCrossRef Saeidi N, Meoli L, Nestoridi E, Gupta NK, Kvas S, Kucharczyk J, et al. Reprogramming of intestinal glucose metabolism and glycemic control in rats after gastric bypass. Science. 2013;341:406–10.PubMedCrossRef
Metadata
Title
Diabetes Remission Following Metabolic Surgery: Is GLP-1 the Culprit?
Authors
Josep Vidal
Amanda Jiménez
Publication date
01-10-2013
Publisher
Springer US
Published in
Current Atherosclerosis Reports / Issue 10/2013
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-013-0357-1

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