Postprandial GLP-2 Levels Are Increased After Biliopancreatic Diversion in Diabetic Individuals with Class I Obesity: a Prospective Study

Abstract

Biliopancreatic diversion (BPD) is a predominantly malabsorptive procedure. Glucagon-like peptide 2 (GLP-2) plays predominantly trophic effects on the gut. A significant increase in GLP-2 after BPD in rats was previously observed, but there are no studies investigating the effect of BPD in GLP-2 levels in humans. The aim of this study is to evaluate the influence of BPD on the release of GLP-2. This is a prospective cohort study that evaluated diabetic individuals with class I obesity which underwent BPD (Scopinaro operation) and were followed up for 12months. Of 12 individuals, four did not comply with the proposed follow-up and were excluded from the analysis. GLP-2 levels were determined by means of an enzyme-linked immunosorbent assay (ELISA), and we collected serial lab samples through a standard meal tolerance test (MTT) in the immediate preoperative period and 12months after surgery. During standard MTT, we observed significant increases of GLP-2 levels from 15 to 60min (respectively, at 15min, 5.7±3.4 versus 12.4±4.3, p=0.029; 30min, 6±3.5 versus 14.6±3.9; p=0.004; 45min, 5.6±4.1 versus 12.6±5.2, p=0.013; 60min, 5.8±2.9 versus 10.6±5.6, p=0.022); then it began to gradually decrease to levels close to the basal. Our findings have confirmed that there is a significant increase in GLP-2 levels after BPD in humans. GLP-2 plays a number of roles which may be adaptive, compensatory, and beneficial in the context of BPD. The clinical implications of this finding remain to be completely understood.