Preserved Insulin Secretory Capacity and Weight Loss Are the Predominant Predictors of Glycemic Control in Patients With Type 2 Diabetes Randomized to Roux-en-Y Gastric Bypass
Improvement in type 2 diabetes after Roux-en-Y gastric bypass (RYGB) has been attributed partly to weight loss, but mechanisms beyond weight loss remain unclear. We performed an ancillary study to the Diabetes Surgery Study to assess changes in incretins, insulin sensitivity, and secretion 1 year af...
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| creator | Nguyen, Kim T Billington, Charles J Vella, Adrian Wang, Qi Ahmed, Leaque Bantle, John P Bessler, Marc Connett, John E Inabnet, William B Thomas, Avis Ikramuddin, Sayeed Korner, Judith |
| description | Improvement in type 2 diabetes after Roux-en-Y gastric bypass (RYGB) has been attributed partly to weight loss, but mechanisms beyond weight loss remain unclear. We performed an ancillary study to the Diabetes Surgery Study to assess changes in incretins, insulin sensitivity, and secretion 1 year after randomization to lifestyle modification and intensive medical management (LS/IMM) alone (n = 34) or in conjunction with RYGB (n = 34). The RYGB group lost more weight and had greater improvement in HbA1c. Fasting glucose was lower after RYGB than after LS/IMM, although the glucose area under the curve decreased comparably for both groups. Insulin sensitivity increased in both groups. Insulin secretion was unchanged after LS/IMM but decreased after RYGB, except for a rapid increase during the first 30 min after meal ingestion. Glucagon-like peptide 1 (GLP-1) was substantially increased after RYGB, while gastric inhibitory polypeptide and glucagon decreased. Lower HbA1c was most strongly correlated with the percentage of weight loss for both groups. At baseline, a greater C-peptide index and 90-min postprandial C-peptide level were predictive of lower HbA1c at 1 year after RYGB. β-Cell glucose sensitivity, which improved only after RYGB, and improved disposition index were associated with lower HbA1c in both groups, independent of weight loss. Weight loss and preserved β-cell function both predominantly determine the greatest glycemic benefit after RYGB. |
| doi_str_mv | 10.2337/db14-1870 |
| format | Article |
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We performed an ancillary study to the Diabetes Surgery Study to assess changes in incretins, insulin sensitivity, and secretion 1 year after randomization to lifestyle modification and intensive medical management (LS/IMM) alone (n = 34) or in conjunction with RYGB (n = 34). The RYGB group lost more weight and had greater improvement in HbA1c. Fasting glucose was lower after RYGB than after LS/IMM, although the glucose area under the curve decreased comparably for both groups. Insulin sensitivity increased in both groups. Insulin secretion was unchanged after LS/IMM but decreased after RYGB, except for a rapid increase during the first 30 min after meal ingestion. Glucagon-like peptide 1 (GLP-1) was substantially increased after RYGB, while gastric inhibitory polypeptide and glucagon decreased. Lower HbA1c was most strongly correlated with the percentage of weight loss for both groups. At baseline, a greater C-peptide index and 90-min postprandial C-peptide level were predictive of lower HbA1c at 1 year after RYGB. β-Cell glucose sensitivity, which improved only after RYGB, and improved disposition index were associated with lower HbA1c in both groups, independent of weight loss. Weight loss and preserved β-cell function both predominantly determine the greatest glycemic benefit after RYGB.</description><identifier>ISSN: 0012-1797</identifier><identifier>EISSN: 1939-327X</identifier><identifier>DOI: 10.2337/db14-1870</identifier><identifier>PMID: 25901097</identifier><identifier>CODEN: DIAEAZ</identifier><language>eng</language><publisher>United States: American Diabetes Association</publisher><subject>Adiponectin - metabolism ; Blood Glucose - metabolism ; C-Peptide - metabolism ; Diabetes ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - metabolism ; Disease management ; Female ; Gastric Bypass ; Gastric Inhibitory Polypeptide - metabolism ; Glucagon - metabolism ; Glucagon-Like Peptide 1 - metabolism ; Glucagon-Like Peptide 2 - metabolism ; Glucose ; Glycated Hemoglobin A - metabolism ; Humans ; Hypoglycemic Agents - therapeutic use ; Insulin ; Insulin - metabolism ; Insulin Resistance ; Insulin Secretion ; Insulin-Secreting Cells - metabolism ; Male ; Middle Aged ; Obesity - complications ; Obesity - metabolism ; Obesity - surgery ; Obesity Studies ; Peptides ; Treatment Outcome ; Weight ; Weight Loss</subject><ispartof>Diabetes (New York, N.Y.), 2015-09, Vol.64 (9), p.3104-3110</ispartof><rights>2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.</rights><rights>Copyright American Diabetes Association Sep 2015</rights><rights>2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-d9618714899fd1b503c4ec9b758b47d01233dcff64dd15da454b9a297f44b0e63</citedby><cites>FETCH-LOGICAL-c436t-d9618714899fd1b503c4ec9b758b47d01233dcff64dd15da454b9a297f44b0e63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542441/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542441/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25901097$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nguyen, Kim T</creatorcontrib><creatorcontrib>Billington, Charles J</creatorcontrib><creatorcontrib>Vella, Adrian</creatorcontrib><creatorcontrib>Wang, Qi</creatorcontrib><creatorcontrib>Ahmed, Leaque</creatorcontrib><creatorcontrib>Bantle, John P</creatorcontrib><creatorcontrib>Bessler, Marc</creatorcontrib><creatorcontrib>Connett, John E</creatorcontrib><creatorcontrib>Inabnet, William B</creatorcontrib><creatorcontrib>Thomas, Avis</creatorcontrib><creatorcontrib>Ikramuddin, Sayeed</creatorcontrib><creatorcontrib>Korner, Judith</creatorcontrib><title>Preserved Insulin Secretory Capacity and Weight Loss Are the Predominant Predictors of Glycemic Control in Patients With Type 2 Diabetes Randomized to Roux-en-Y Gastric Bypass</title><title>Diabetes (New York, N.Y.)</title><addtitle>Diabetes</addtitle><description>Improvement in type 2 diabetes after Roux-en-Y gastric bypass (RYGB) has been attributed partly to weight loss, but mechanisms beyond weight loss remain unclear. We performed an ancillary study to the Diabetes Surgery Study to assess changes in incretins, insulin sensitivity, and secretion 1 year after randomization to lifestyle modification and intensive medical management (LS/IMM) alone (n = 34) or in conjunction with RYGB (n = 34). The RYGB group lost more weight and had greater improvement in HbA1c. Fasting glucose was lower after RYGB than after LS/IMM, although the glucose area under the curve decreased comparably for both groups. Insulin sensitivity increased in both groups. Insulin secretion was unchanged after LS/IMM but decreased after RYGB, except for a rapid increase during the first 30 min after meal ingestion. Glucagon-like peptide 1 (GLP-1) was substantially increased after RYGB, while gastric inhibitory polypeptide and glucagon decreased. Lower HbA1c was most strongly correlated with the percentage of weight loss for both groups. At baseline, a greater C-peptide index and 90-min postprandial C-peptide level were predictive of lower HbA1c at 1 year after RYGB. β-Cell glucose sensitivity, which improved only after RYGB, and improved disposition index were associated with lower HbA1c in both groups, independent of weight loss. Weight loss and preserved β-cell function both predominantly determine the greatest glycemic benefit after RYGB.</description><subject>Adiponectin - metabolism</subject><subject>Blood Glucose - metabolism</subject><subject>C-Peptide - metabolism</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes Mellitus, Type 2 - metabolism</subject><subject>Disease management</subject><subject>Female</subject><subject>Gastric Bypass</subject><subject>Gastric Inhibitory Polypeptide - metabolism</subject><subject>Glucagon - metabolism</subject><subject>Glucagon-Like Peptide 1 - metabolism</subject><subject>Glucagon-Like Peptide 2 - metabolism</subject><subject>Glucose</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>Humans</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Insulin</subject><subject>Insulin - metabolism</subject><subject>Insulin Resistance</subject><subject>Insulin Secretion</subject><subject>Insulin-Secreting Cells - metabolism</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Obesity - complications</subject><subject>Obesity - metabolism</subject><subject>Obesity - surgery</subject><subject>Obesity Studies</subject><subject>Peptides</subject><subject>Treatment Outcome</subject><subject>Weight</subject><subject>Weight Loss</subject><issn>0012-1797</issn><issn>1939-327X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFksFuFSEUhidGY6_VhS9gSNzoYhQGZhg2JvWq1yY3sak11RVh4EwvzVwYgWkcX8pXlLG1UTeGBSR85-fnnL8oHhP8oqKUvzQdYSVpOb5TrIigoqQV_3y3WGFMqpJwwQ-KBzFeYoybvO4XB1UtMMGCr4ofJwEihCsw6NjFabAOfQQdIPkwo7UalbZpRsoZdA72YpfQ1seIjgKgtAOUi43fW6dc-nW2OtdF5Hu0GWYNe6vR2rsU_ICy8IlKFlyK6NymHTqbR0AVemNVBwkiOs2PZK3v2Uny6NRP30pw5Re0UTGFLPR6HlWMD4t7vRoiPLrZD4tP796erd-X2w-b4_XRttSMNqk0osn9IKwVojekqzHVDLToeN12jJvcF0qN7vuGGUNqo1jNOqEqwXvGOgwNPSxeXeuOU7cHo7PvoAY5BrtXYZZeWfn3jbM7eeGvZFaqGCNZ4NmNQPBfJ4hJ7m3UMAzKgZ-iJK3gtBGYVf9HOW4q3Ip2QZ_-g176KbjciYVq88DrVmTq-TWlQ55WgP7WN8FySYxcEiOXxGT2yZ8fvSV_R4T-BIxUvbk</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>Nguyen, Kim T</creator><creator>Billington, Charles J</creator><creator>Vella, Adrian</creator><creator>Wang, Qi</creator><creator>Ahmed, Leaque</creator><creator>Bantle, John P</creator><creator>Bessler, Marc</creator><creator>Connett, John E</creator><creator>Inabnet, William B</creator><creator>Thomas, Avis</creator><creator>Ikramuddin, Sayeed</creator><creator>Korner, Judith</creator><general>American Diabetes Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>7TS</scope><scope>5PM</scope></search><sort><creationdate>20150901</creationdate><title>Preserved Insulin Secretory Capacity and Weight Loss Are the Predominant Predictors of Glycemic Control in Patients With Type 2 Diabetes Randomized to Roux-en-Y Gastric Bypass</title><author>Nguyen, Kim T ; Billington, Charles J ; Vella, Adrian ; Wang, Qi ; Ahmed, Leaque ; Bantle, John P ; Bessler, Marc ; Connett, John E ; Inabnet, William B ; Thomas, Avis ; Ikramuddin, Sayeed ; Korner, Judith</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-d9618714899fd1b503c4ec9b758b47d01233dcff64dd15da454b9a297f44b0e63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adiponectin - metabolism</topic><topic>Blood Glucose - metabolism</topic><topic>C-Peptide - metabolism</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Diabetes Mellitus, Type 2 - metabolism</topic><topic>Disease management</topic><topic>Female</topic><topic>Gastric Bypass</topic><topic>Gastric Inhibitory Polypeptide - metabolism</topic><topic>Glucagon - metabolism</topic><topic>Glucagon-Like Peptide 1 - metabolism</topic><topic>Glucagon-Like Peptide 2 - metabolism</topic><topic>Glucose</topic><topic>Glycated Hemoglobin A - metabolism</topic><topic>Humans</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Insulin</topic><topic>Insulin - metabolism</topic><topic>Insulin Resistance</topic><topic>Insulin Secretion</topic><topic>Insulin-Secreting Cells - metabolism</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Obesity - complications</topic><topic>Obesity - metabolism</topic><topic>Obesity - surgery</topic><topic>Obesity Studies</topic><topic>Peptides</topic><topic>Treatment Outcome</topic><topic>Weight</topic><topic>Weight Loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nguyen, Kim T</creatorcontrib><creatorcontrib>Billington, Charles J</creatorcontrib><creatorcontrib>Vella, Adrian</creatorcontrib><creatorcontrib>Wang, Qi</creatorcontrib><creatorcontrib>Ahmed, Leaque</creatorcontrib><creatorcontrib>Bantle, John P</creatorcontrib><creatorcontrib>Bessler, Marc</creatorcontrib><creatorcontrib>Connett, John E</creatorcontrib><creatorcontrib>Inabnet, William B</creatorcontrib><creatorcontrib>Thomas, Avis</creatorcontrib><creatorcontrib>Ikramuddin, Sayeed</creatorcontrib><creatorcontrib>Korner, Judith</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>Physical Education Index</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diabetes (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nguyen, Kim T</au><au>Billington, Charles J</au><au>Vella, Adrian</au><au>Wang, Qi</au><au>Ahmed, Leaque</au><au>Bantle, John P</au><au>Bessler, Marc</au><au>Connett, John E</au><au>Inabnet, William B</au><au>Thomas, Avis</au><au>Ikramuddin, Sayeed</au><au>Korner, Judith</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preserved Insulin Secretory Capacity and Weight Loss Are the Predominant Predictors of Glycemic Control in Patients With Type 2 Diabetes Randomized to Roux-en-Y Gastric Bypass</atitle><jtitle>Diabetes (New York, N.Y.)</jtitle><addtitle>Diabetes</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>64</volume><issue>9</issue><spage>3104</spage><epage>3110</epage><pages>3104-3110</pages><issn>0012-1797</issn><eissn>1939-327X</eissn><coden>DIAEAZ</coden><abstract>Improvement in type 2 diabetes after Roux-en-Y gastric bypass (RYGB) has been attributed partly to weight loss, but mechanisms beyond weight loss remain unclear. We performed an ancillary study to the Diabetes Surgery Study to assess changes in incretins, insulin sensitivity, and secretion 1 year after randomization to lifestyle modification and intensive medical management (LS/IMM) alone (n = 34) or in conjunction with RYGB (n = 34). The RYGB group lost more weight and had greater improvement in HbA1c. Fasting glucose was lower after RYGB than after LS/IMM, although the glucose area under the curve decreased comparably for both groups. Insulin sensitivity increased in both groups. Insulin secretion was unchanged after LS/IMM but decreased after RYGB, except for a rapid increase during the first 30 min after meal ingestion. Glucagon-like peptide 1 (GLP-1) was substantially increased after RYGB, while gastric inhibitory polypeptide and glucagon decreased. Lower HbA1c was most strongly correlated with the percentage of weight loss for both groups. At baseline, a greater C-peptide index and 90-min postprandial C-peptide level were predictive of lower HbA1c at 1 year after RYGB. β-Cell glucose sensitivity, which improved only after RYGB, and improved disposition index were associated with lower HbA1c in both groups, independent of weight loss. Weight loss and preserved β-cell function both predominantly determine the greatest glycemic benefit after RYGB.</abstract><cop>United States</cop><pub>American Diabetes Association</pub><pmid>25901097</pmid><doi>10.2337/db14-1870</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Adiponectin - metabolism Blood Glucose - metabolism C-Peptide - metabolism Diabetes Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - metabolism Disease management Female Gastric Bypass Gastric Inhibitory Polypeptide - metabolism Glucagon - metabolism Glucagon-Like Peptide 1 - metabolism Glucagon-Like Peptide 2 - metabolism Glucose Glycated Hemoglobin A - metabolism Humans Hypoglycemic Agents - therapeutic use Insulin Insulin - metabolism Insulin Resistance Insulin Secretion Insulin-Secreting Cells - metabolism Male Middle Aged Obesity - complications Obesity - metabolism Obesity - surgery Obesity Studies Peptides Treatment Outcome Weight Weight Loss |
| title | Preserved Insulin Secretory Capacity and Weight Loss Are the Predominant Predictors of Glycemic Control in Patients With Type 2 Diabetes Randomized to Roux-en-Y Gastric Bypass |
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