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Calorie Restriction is a Major Determinant of the Short‐Term Metabolic Effects of Gastric Bypass Surgery in Obese Type 2 Diabetic Patients
Author(s) -
Lips Mirjam A.,
Groot Gerrit H.,
Klinken Jan B.,
Aarts Edo,
Berends Frits J.,
Janssen Ignace M.,
Ramshorst Bert,
Wagensveld Bart A.,
Swank Dingeman J.,
Dielen Francois,
Willems van Dijk Ko,
Pijl Hanno
Publication year - 2014
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12254
Subject(s) - medicine , endocrinology , calorie restriction , hyperinsulinemia , weight loss , postprandial , very low calorie diet , type 2 diabetes , insulin , diabetes mellitus , obesity , insulin resistance
Summary Objective Roux‐en‐Y gastric bypass ( RYGB ) and restrictive weight loss interventions, such as gastric banding ( GB ) and very‐low‐calorie diets ( VLCD ) directly impact glucose metabolism, possibly by calorie restriction and/or altered secretion of gut hormones. We aimed to establish the direct endocrine and metabolic effects of RYGB compared to restrictive interventions in obese glucose‐tolerant ( NGT ) subjects and subjects with type 2 diabetes (T2 DM ). Design Controlled, nonrandomized observational trial. Patients and measurements Four groups of obese females received a mixed meal at baseline and 3 weeks after intervention; NGT ‐ GB ( n = 11), NGT ‐ RYGB ( n = 16), T2 DM ‐ RYGB ( n = 15) and T2 DM ‐ VLCD ( n = 12). Normal weight controls ( n = 12) were studied once. Results At baseline, all obese subjects were hyperinsulinemic. T2 DM was associated with hyperglycaemia and decreased GLP ‐1 levels. RYGB and VLCD reduced glucose levels to a similar extent in T2 DM , insulin levels decreased only after VLCD . Comparison of restrictive intervention vs RYGB showed a more pronounced decrease in glucose and insulin AUC after restriction. In NGT and T2 DM subjects, RYGB increased GLP ‐1 and PYY levels and decreased ghrelin levels, whereas VLCD and GB only increased GIP levels. Conclusions These data indicate that deterioration of glucose metabolism in T2 DM is associated with a decline of GLP ‐1 levels. Calorie restriction facilitates glucose metabolism and blunts hyperinsulinemia in obese (diabetic) humans. Additional duodenal exclusion through RYGB induces gut hormone release and hyperinsulinemia but does not improve postprandial glucose levels any further. Our data thus strongly suggest that calorie restriction underlies the short‐term metabolic benefits of RYGB in obese T2 DM patients.