Abstract
ContextRoux-en-Y gastric bypass surgery (RYGB) markedly improves glycemia in patients with type 2 diabetes (T2D), but underlying mechanisms and changes over time are incompletely understood.ObjectiveIntegrated assessment of neuroendocrine and metabolic changes over time in T2D patients undergoing RYGB.Design and SettingFollow-up of single-center randomized study.PatientsThirteen patients with obesity and T2D compared to 22 healthy subjects.InterventionsBlood chemistry, adipose biopsies, and heart rate variability were obtained before and 4, 24, and 104 weeks post-RYGB.ResultsAfter RYGB, glucose-lowering drugs were discontinued and hemoglobin A1c fell from mean 55 to 41 mmol/mol by 104 weeks (P < 0.001). At 4 weeks, morning cortisol (P < 0.05) and adrenocorticotropin (P = 0.09) were reduced by 20%. Parasympathetic nerve activity (heart rate variability derived) increased at 4 weeks (P < 0.05) and peaked at 24 weeks (P < 0.01). C-reactive protein (CRP) and white blood cells were rapidly reduced (P < 0.01). At 104 weeks, basal and insulin-stimulated adipocyte glucose uptake increased by 3-fold vs baseline and expression of genes involved in glucose transport, fatty acid oxidation, and adipogenesis was upregulated (P < 0.01). Adipocyte volume was reduced by 4 weeks and more markedly at 104 weeks, by about 40% vs baseline (P < 0.01).ConclusionsWe propose this order of events: (1) rapid glucose lowering (days); (2) attenuated cortisol axis activity and inflammation and increased parasympathetic tone (weeks); and (3) body fat and weight loss, increased adipose glucose uptake, and whole-body insulin sensitivity (months-years; similar to healthy controls). Thus, neuroendocrine pathways can partly mediate early glycemic improvement after RYGB, and adipose factors may promote long-term insulin sensitivity and normoglycemia.
Highlights
The Journal of Clinical Endocrinology & Metabolism, 2021, Vol 106, No 10. We propose this order of events: [1] rapid glucose lowering; [2] attenuated cortisol axis activity and inflammation and increased parasympathetic tone; and [3] body fat and weight loss, increased adipose glucose uptake, and wholebody insulin sensitivity.neuroendocrine pathways can partly mediate early glycemic improvement after Roux-en-Y gastric bypass surgery (RYGB), and adipose factors may promote long-term insulin sensitivity and normoglycemia
Roux-en-Y gastric bypass (RYGB) has been the most common procedure in the last decades, and it results in about 60% average loss of excess body weight [6,7]
Plasma Free fatty acids (FFAs) area under the curve (AUC) during oral glucose tolerance tests (OGTTs) was reduced at 24 and 104 weeks compared to baseline and glycerol AUC during the OGTT was reduced at 104 weeks (Table 1)
Summary
The aim of this report is to address metabolic and neuroendocrine changes as they occur over a longer, 2-year time period after RYGB
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: The Journal of Clinical Endocrinology & Metabolism
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
