Abstract
BackgroundGastric bypass surgery seems to have an effect on glucose metabolism beyond what is mediated through weight reduction. The magnitude of this effect on fasting and post-challenge glucose levels remains unknown.ResultsMorbidly obese subjects without known diabetes performed a 75 g oral glucose tolerance test before and after either gastric bypass surgery (n = 64) or an intensive lifestyle intervention programme (n = 55), ClinicalTrials.gov identifier NCT00273104. The age-adjusted effects of the therapeutic procedures and percentage weight change on fasting and 2-h glucose levels at 1 year were explored using multiple linear regression analysis. Mean (SD) serum fasting and 2-h glucose levels at baseline did not differ between the surgery and lifestyle groups. Weight-loss after surgical treatment and lifestyle intervention was 30 (8) and 9 (10) % (p < 0.001). At 1 year, fasting and 2-h glucose levels were significantly lower in the surgery group than in the lifestyle group, 4.7 (0.4) versus 5.4 (0.7) mmol/l and 3.4 (0.8) versus 6.0 (2.4) mmol/l, respectively (both p < 0.001). Gastric bypass and weight-loss had both independent glucose-lowering effects on 2-h glucose levels [B (95 % CI) 1.4 (0.6–2.3) mmol/l and 0.4 (0.1–0.7) mmol/l per 10 % weight-loss, respectively]. Fasting glucose levels were determined by weight change [0.2 (0.1–0.3) mmol/l per 10 % weight-loss] and not by type of treatment.ConclusionsGastric bypass surgery has a clinically relevant glucose-lowering effect on post-challenge glucose levels which is seemingly not mediated through weight-loss alone.
Highlights
Gastric bypass surgery seems to have an effect on glucose metabolism beyond what is mediated through weight reduction
The independent effects of treatment choice and weight change on fasting and 2-h glucose levels were explored in two regression models (Table 1)
Gastric bypass surgery had an independent effect on 2-h glucose levels but not on fasting glucose levels at 1 year (Table 1)
Summary
Gastric bypass surgery seems to have an effect on glucose metabolism beyond what is mediated through weight reduction. A weight-loss independent effect of the surgical procedure on glucose metabolism has been hypothesized [2, 3]. The relative effects of weight loss and the surgical procedure per se on fasting and post-challenge glucose levels remain, unknown. The inclusion of a non-surgical weight-loss group made it possible to assess the specific effect of the surgical procedure on fasting and post-challenge glucose levels. To our knowledge, this has previously only been addressed in a few small studies [8, 9]
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