A Meta-Analysis of GLP-1 After Roux-En-Y Gastric Bypass: Impact of Surgical Technique and Measurement Strategy.

Abstract

Roux-en-Y gastric bypass (RYGB) is an effective treatment for diabetes. Glucagon-like peptide-1 (GLP-1) is a gut hormone that is important to glucose homeostasis. This study aimed to assess GLP-1 level and its predictors after RYGB. The study design was a meta-analysis. The data sources were MEDLINE, EMBASE, Web of Science, and the Cochrane Databases. The study selection composed of studies with pre- and post-RYGB levels. The main outcomes were as follows: Primary outcome was the change in postprandial GLP-1 levels after RYGB. Secondary outcomes included the changes in fasting glucose, fasting insulin, and fasting GLP-1 levels after RYGB. Meta-regression to determine predictors of changes in GLP-1 levels was performed. Outcomes were reported using Hedge's g. Twenty-four studies with 368 patients were included. Postprandial GLP-1 levels increased after RYGB (Hedge's g=1.29, p<0.0001), while fasting GLP-1 did not change (p=0.23). Peak postprandial GLP-1 levels gave the most consistent results (I 2=9.11). Fasting glucose and insulin levels decreased after RYGB (p<0.0001). Roux limb length was a significant predictor for amount of GLP-1 increase (β=-0.01, p=0.02). Diabetes status, amount of weight loss, length of biliopancreatic limb, and time of measurement were not significant predictors (p>0.05). Postprandial GLP-1 levels increase after RYGB, while fasting levels remain unchanged. Shorter Roux limb length is associated with greater increase in postprandial GLP-1, which may lead to better glycemic control in this population.