Multiple Factors Lead to a Low Referral Rate for Bariatric Surgery in an Urban Primary Care Setting

Abstract

Introduction The reported remission of type 2 diabetes in patients undergoing Roux-en-Y gastric bypass has brought the role of the gut in glucose metabolism in focus. We aimed to explore the role of the proximal gut on glucose handling.Methods A comparative controlled investigation of oral versus gastrostomy glucose loading in patients who had previously undergone gastric bypass and had a gastrostomy tube in the gastric remnant for feeding. A standard glucose load was administered either orally (day 1) or via the gastrostomy tube (day 2). Plasma levels of glucose, insulin, glucagon-like peptide 1 (GLP-1) and peptide YY (PYY) were measured pre and post glucose loading. Results Exclusion of the proximal small gut from glucose passage induced lower plasma glucose responses and higher plasma insulin, GLP-1 and PYY responses compared to glucose via a gastrostomy (p<0.05). Conclusions Exclusion of glucose passage through the proximal small gut results in enhanced insulin and gut hormone responses and suggests a weight loss independent effect explaining the improved glycaemic control after gastric bypass. The gut plays a central role in glucose metabolism and represents a target for future antidiabetes therapies.