Rapid changes in neuroendocrine regulation may contribute to reversal of type 2 diabetes after gastric bypass surgery

Petros Katsogiannos,Maria J Pereira,F Anders Karlsson,Jan W Eriksson,Magnus Sundbom,Ulf Hammar,Urban Wiklund,Daniel Espes,Prasad G Kamble

doi:10.1007/s12020-020-02203-w

Petros Katsogiannos, Maria J Pereira + Show 7 more

Open Access

https://doi.org/10.1007/s12020-020-02203-w

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Journal: Endocrine	Publication Date: Jan 26, 2020
Citations: 20	License type: open-access

Affiliation: Uppsala University, Umeå University

Abstract

ObjectiveTo explore the role of hormones and the autonomic nervous system in the rapid remission of diabetes after Roux-en-Y Gastric Bypass (RYGB).Research design and methodsNineteen obese patients with type 2 diabetes, 7 M/12 F, were randomized (2:1) to RYGB or standard-of-care medical treatment (control). At baseline and 4 and 24 weeks post surgery, fasting blood sampling, OGTT, intravenous arginine challenge, and heart-rate variability (HRV) assessments were performed.ResultsAt both 4 and 24 weeks post-RYGB the following effects were found: arginine-stimulated insulin secretion was reduced. GLP-1, GIP, and glucagon rise during OGTT was enhanced. IGF-1 and GH levels increased. In addition, total HRV and spectral components PLF (power of low frequency) and PHF (power of high frequency) increased. At 4 weeks, morning cortisol was lower than baseline and 24 weeks. At 24 weeks, NEFA levels during OGTT, and the PLF/PHF ratio decreased. None of these changes were seen in the control group.ConclusionsThere were rapid changes within 4 weeks after RYGB: signs of enhanced parasympathetic nerve activity, reduced morning cortisol, and enhanced incretin and glucagon responses to glucose. The findings suggest that neurohormonal mechanisms can contribute to the rapid improvement of insulin resistance and glycemia following RYGB in type 2 diabetes.

Highlights

Bariatric surgery, in particular, Roux-en-Y Gastric Bypass (RYGB), markedly improves glycemic control and canThese authors contributed : Petros Katsogiannos, Prasad G
Total glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) levels were measured in plasma during fasting and OGTT at different visits (Table 2, Fig. 1)
GLP-1 response during OGTT was higher at both 4 and 24 weeks post surgery compared with baseline (Fig. 1a)

Summary

Conclusions

There were rapid changes within 4 weeks after RYGB: signs of enhanced parasympathetic nerve activity, reduced morning cortisol, and enhanced incretin and glucagon responses to glucose.

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