Assessment of glucose regulation in pregnancy after gastric bypass surgery
Aims/hypothesis Roux-en-Y gastric bypass (RYGB) surgery is characterised by glycaemic variability. Prospective studies of glucose metabolism in pregnancy after RYGB are not available, therefore this study aimed to evaluate physiological alterations in glucose metabolism in pregnancy following RYGB....
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| Veröffentlicht in: | Diabetologia 2017-12, Vol.60 (12), p.2504-2513 |
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| creator | Göbl, Christian S. Bozkurt, Latife Tura, Andrea Leutner, Michael Andrei, Laura Fahr, Lukas Husslein, Peter Eppel, Wolfgang Kautzky-Willer, Alexandra |
| description | Aims/hypothesis
Roux-en-Y gastric bypass (RYGB) surgery is characterised by glycaemic variability. Prospective studies of glucose metabolism in pregnancy after RYGB are not available, therefore this study aimed to evaluate physiological alterations in glucose metabolism in pregnancy following RYGB.
Methods
Sixty-three pregnant women (25 who underwent RYGB, 19 non-operated obese control women and 19 normal weight control women) were included. Frequently sampled 3 h OGTTs and 1 h IVGTTs were performed between 24 and 28 weeks of gestation and, in a subgroup, were repeated at 3–6 months after delivery.
Results
We observed major alterations in glucose kinetics during the OGTT, including an early increase in plasma glucose followed by hypoglycaemia in 90% of women who had previously undergone RYGB. The higher degree of glycaemic variability in this group was accompanied by increased insulin, C-peptide and glucagon concentrations after oral glucose load, whereas no differences in insulin response were observed after parenteral glucose administration (RYGB vs normal weight). IVGTT data suggested improved insulin sensitivity (mean difference 0.226 × 10
−4
min
−1
[pmol/l]
−1
[95% CI 0.104, 0.348];
p
|
| doi_str_mv | 10.1007/s00125-017-4437-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6448941</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1960344631</sourcerecordid><originalsourceid>FETCH-LOGICAL-c470t-e153c1fc2743020cba01ba66a31a2c7ed81a51eff52e60a8fb2e95e36c14d6433</originalsourceid><addsrcrecordid>eNp1kU-LFDEQxYMo7rj6AbxIwIuX1qokne6-CMui7sqCFwVvIZ2pbnvpScZUtzDf3gyzLqvgKYT3q1d_nhAvEd4iQPOOAVDVFWBTGaObyj4SGzRaVWBU-1hsjnKFrf1-Jp4x3wKAro19Ks5U22FrGtiIzxfMxLyjuMg0yHFeQ2KSmcZ19suUopyi3Jdv9DEcpB8WynL0vOQpyP6w98yS1zxSPjwXTwY_M724e8_Ft48fvl5eVTdfPl1fXtxUoXRcKsJaBxyCaowGBaH3gL231mv0KjS0bdHXSMNQK7Lg26FX1NWkbUCztUbrc_H-5Ltf-x1tQxk9-9nt87Tz-eCSn9zfSpx-uDH9ctaYtjNYDN7cGeT0cyVe3G7iQPPsI6WVHXYGsGub2hT09T_obVpzLOsVyoI2xuqjIZ6okBNzpuF-GAR3TMqdknIlKXdMytlS8-rhFvcVf6IpgDoBXKRYDvyg9X9dfwPuG5-4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1960344631</pqid></control><display><type>article</type><title>Assessment of glucose regulation in pregnancy after gastric bypass surgery</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Göbl, Christian S. ; Bozkurt, Latife ; Tura, Andrea ; Leutner, Michael ; Andrei, Laura ; Fahr, Lukas ; Husslein, Peter ; Eppel, Wolfgang ; Kautzky-Willer, Alexandra</creator><creatorcontrib>Göbl, Christian S. ; Bozkurt, Latife ; Tura, Andrea ; Leutner, Michael ; Andrei, Laura ; Fahr, Lukas ; Husslein, Peter ; Eppel, Wolfgang ; Kautzky-Willer, Alexandra</creatorcontrib><description>Aims/hypothesis
Roux-en-Y gastric bypass (RYGB) surgery is characterised by glycaemic variability. Prospective studies of glucose metabolism in pregnancy after RYGB are not available, therefore this study aimed to evaluate physiological alterations in glucose metabolism in pregnancy following RYGB.
Methods
Sixty-three pregnant women (25 who underwent RYGB, 19 non-operated obese control women and 19 normal weight control women) were included. Frequently sampled 3 h OGTTs and 1 h IVGTTs were performed between 24 and 28 weeks of gestation and, in a subgroup, were repeated at 3–6 months after delivery.
Results
We observed major alterations in glucose kinetics during the OGTT, including an early increase in plasma glucose followed by hypoglycaemia in 90% of women who had previously undergone RYGB. The higher degree of glycaemic variability in this group was accompanied by increased insulin, C-peptide and glucagon concentrations after oral glucose load, whereas no differences in insulin response were observed after parenteral glucose administration (RYGB vs normal weight). IVGTT data suggested improved insulin sensitivity (mean difference 0.226 × 10
−4
min
−1
[pmol/l]
−1
[95% CI 0.104, 0.348];
p
< 0.001) and disposition index in pregnancies after RYGB when compared with obese control women. However, subtle alterations in insulin action and beta cell function were still observed when comparing women who had undergone RYGB with the normal-weight control group. Moreover, we observed that fetal growth was associated with maternal glucose nadir levels and insulin secretion in offspring of those who had previously undergone RYGB.
Conclusions/interpretation
Pregnancies after RYGB are affected by altered postprandial glucose, insulin and C-peptide dynamics. Insulin sensitivity is improved by RYGB, although subtle alterations in beta cell function are observed. Longitudinal studies are needed to assess potential consequences for fetal development and pregnancy outcomes.</description><identifier>ISSN: 0012-186X</identifier><identifier>EISSN: 1432-0428</identifier><identifier>DOI: 10.1007/s00125-017-4437-6</identifier><identifier>PMID: 28918470</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Beta cells ; Blood Glucose - metabolism ; C-Peptide - metabolism ; Female ; Fetuses ; Gastric Bypass ; Gastrointestinal surgery ; Gestation ; Glucagon ; Glucose ; Glucose - metabolism ; Glucose Tolerance Test ; Human Physiology ; Humans ; Hypoglycemia ; Insulin ; Insulin - metabolism ; Insulin secretion ; Internal Medicine ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Metabolism ; Obesity - metabolism ; Pregnancy ; Prospective Studies ; Secretion ; Surgery</subject><ispartof>Diabetologia, 2017-12, Vol.60 (12), p.2504-2513</ispartof><rights>The Author(s) 2017</rights><rights>Diabetologia is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-e153c1fc2743020cba01ba66a31a2c7ed81a51eff52e60a8fb2e95e36c14d6433</citedby><cites>FETCH-LOGICAL-c470t-e153c1fc2743020cba01ba66a31a2c7ed81a51eff52e60a8fb2e95e36c14d6433</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00125-017-4437-6$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00125-017-4437-6$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,315,782,786,887,27933,27934,41497,42566,51328</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28918470$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Göbl, Christian S.</creatorcontrib><creatorcontrib>Bozkurt, Latife</creatorcontrib><creatorcontrib>Tura, Andrea</creatorcontrib><creatorcontrib>Leutner, Michael</creatorcontrib><creatorcontrib>Andrei, Laura</creatorcontrib><creatorcontrib>Fahr, Lukas</creatorcontrib><creatorcontrib>Husslein, Peter</creatorcontrib><creatorcontrib>Eppel, Wolfgang</creatorcontrib><creatorcontrib>Kautzky-Willer, Alexandra</creatorcontrib><title>Assessment of glucose regulation in pregnancy after gastric bypass surgery</title><title>Diabetologia</title><addtitle>Diabetologia</addtitle><addtitle>Diabetologia</addtitle><description>Aims/hypothesis
Roux-en-Y gastric bypass (RYGB) surgery is characterised by glycaemic variability. Prospective studies of glucose metabolism in pregnancy after RYGB are not available, therefore this study aimed to evaluate physiological alterations in glucose metabolism in pregnancy following RYGB.
Methods
Sixty-three pregnant women (25 who underwent RYGB, 19 non-operated obese control women and 19 normal weight control women) were included. Frequently sampled 3 h OGTTs and 1 h IVGTTs were performed between 24 and 28 weeks of gestation and, in a subgroup, were repeated at 3–6 months after delivery.
Results
We observed major alterations in glucose kinetics during the OGTT, including an early increase in plasma glucose followed by hypoglycaemia in 90% of women who had previously undergone RYGB. The higher degree of glycaemic variability in this group was accompanied by increased insulin, C-peptide and glucagon concentrations after oral glucose load, whereas no differences in insulin response were observed after parenteral glucose administration (RYGB vs normal weight). IVGTT data suggested improved insulin sensitivity (mean difference 0.226 × 10
−4
min
−1
[pmol/l]
−1
[95% CI 0.104, 0.348];
p
< 0.001) and disposition index in pregnancies after RYGB when compared with obese control women. However, subtle alterations in insulin action and beta cell function were still observed when comparing women who had undergone RYGB with the normal-weight control group. Moreover, we observed that fetal growth was associated with maternal glucose nadir levels and insulin secretion in offspring of those who had previously undergone RYGB.
Conclusions/interpretation
Pregnancies after RYGB are affected by altered postprandial glucose, insulin and C-peptide dynamics. Insulin sensitivity is improved by RYGB, although subtle alterations in beta cell function are observed. Longitudinal studies are needed to assess potential consequences for fetal development and pregnancy outcomes.</description><subject>Adult</subject><subject>Beta cells</subject><subject>Blood Glucose - metabolism</subject><subject>C-Peptide - metabolism</subject><subject>Female</subject><subject>Fetuses</subject><subject>Gastric Bypass</subject><subject>Gastrointestinal surgery</subject><subject>Gestation</subject><subject>Glucagon</subject><subject>Glucose</subject><subject>Glucose - metabolism</subject><subject>Glucose Tolerance Test</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Hypoglycemia</subject><subject>Insulin</subject><subject>Insulin - metabolism</subject><subject>Insulin secretion</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Metabolism</subject><subject>Obesity - metabolism</subject><subject>Pregnancy</subject><subject>Prospective Studies</subject><subject>Secretion</subject><subject>Surgery</subject><issn>0012-186X</issn><issn>1432-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kU-LFDEQxYMo7rj6AbxIwIuX1qokne6-CMui7sqCFwVvIZ2pbnvpScZUtzDf3gyzLqvgKYT3q1d_nhAvEd4iQPOOAVDVFWBTGaObyj4SGzRaVWBU-1hsjnKFrf1-Jp4x3wKAro19Ks5U22FrGtiIzxfMxLyjuMg0yHFeQ2KSmcZ19suUopyi3Jdv9DEcpB8WynL0vOQpyP6w98yS1zxSPjwXTwY_M724e8_Ft48fvl5eVTdfPl1fXtxUoXRcKsJaBxyCaowGBaH3gL231mv0KjS0bdHXSMNQK7Lg26FX1NWkbUCztUbrc_H-5Ltf-x1tQxk9-9nt87Tz-eCSn9zfSpx-uDH9ctaYtjNYDN7cGeT0cyVe3G7iQPPsI6WVHXYGsGub2hT09T_obVpzLOsVyoI2xuqjIZ6okBNzpuF-GAR3TMqdknIlKXdMytlS8-rhFvcVf6IpgDoBXKRYDvyg9X9dfwPuG5-4</recordid><startdate>20171201</startdate><enddate>20171201</enddate><creator>Göbl, Christian S.</creator><creator>Bozkurt, Latife</creator><creator>Tura, Andrea</creator><creator>Leutner, Michael</creator><creator>Andrei, Laura</creator><creator>Fahr, Lukas</creator><creator>Husslein, Peter</creator><creator>Eppel, Wolfgang</creator><creator>Kautzky-Willer, Alexandra</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><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>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20171201</creationdate><title>Assessment of glucose regulation in pregnancy after gastric bypass surgery</title><author>Göbl, Christian S. ; Bozkurt, Latife ; Tura, Andrea ; Leutner, Michael ; Andrei, Laura ; Fahr, Lukas ; Husslein, Peter ; Eppel, Wolfgang ; Kautzky-Willer, Alexandra</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-e153c1fc2743020cba01ba66a31a2c7ed81a51eff52e60a8fb2e95e36c14d6433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Beta cells</topic><topic>Blood Glucose - metabolism</topic><topic>C-Peptide - metabolism</topic><topic>Female</topic><topic>Fetuses</topic><topic>Gastric Bypass</topic><topic>Gastrointestinal surgery</topic><topic>Gestation</topic><topic>Glucagon</topic><topic>Glucose</topic><topic>Glucose - metabolism</topic><topic>Glucose Tolerance Test</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Hypoglycemia</topic><topic>Insulin</topic><topic>Insulin - metabolism</topic><topic>Insulin secretion</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Metabolism</topic><topic>Obesity - metabolism</topic><topic>Pregnancy</topic><topic>Prospective Studies</topic><topic>Secretion</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Göbl, Christian S.</creatorcontrib><creatorcontrib>Bozkurt, Latife</creatorcontrib><creatorcontrib>Tura, Andrea</creatorcontrib><creatorcontrib>Leutner, Michael</creatorcontrib><creatorcontrib>Andrei, Laura</creatorcontrib><creatorcontrib>Fahr, Lukas</creatorcontrib><creatorcontrib>Husslein, Peter</creatorcontrib><creatorcontrib>Eppel, Wolfgang</creatorcontrib><creatorcontrib>Kautzky-Willer, Alexandra</creatorcontrib><collection>Springer Nature OA/Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diabetologia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Göbl, Christian S.</au><au>Bozkurt, Latife</au><au>Tura, Andrea</au><au>Leutner, Michael</au><au>Andrei, Laura</au><au>Fahr, Lukas</au><au>Husslein, Peter</au><au>Eppel, Wolfgang</au><au>Kautzky-Willer, Alexandra</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of glucose regulation in pregnancy after gastric bypass surgery</atitle><jtitle>Diabetologia</jtitle><stitle>Diabetologia</stitle><addtitle>Diabetologia</addtitle><date>2017-12-01</date><risdate>2017</risdate><volume>60</volume><issue>12</issue><spage>2504</spage><epage>2513</epage><pages>2504-2513</pages><issn>0012-186X</issn><eissn>1432-0428</eissn><abstract>Aims/hypothesis
Roux-en-Y gastric bypass (RYGB) surgery is characterised by glycaemic variability. Prospective studies of glucose metabolism in pregnancy after RYGB are not available, therefore this study aimed to evaluate physiological alterations in glucose metabolism in pregnancy following RYGB.
Methods
Sixty-three pregnant women (25 who underwent RYGB, 19 non-operated obese control women and 19 normal weight control women) were included. Frequently sampled 3 h OGTTs and 1 h IVGTTs were performed between 24 and 28 weeks of gestation and, in a subgroup, were repeated at 3–6 months after delivery.
Results
We observed major alterations in glucose kinetics during the OGTT, including an early increase in plasma glucose followed by hypoglycaemia in 90% of women who had previously undergone RYGB. The higher degree of glycaemic variability in this group was accompanied by increased insulin, C-peptide and glucagon concentrations after oral glucose load, whereas no differences in insulin response were observed after parenteral glucose administration (RYGB vs normal weight). IVGTT data suggested improved insulin sensitivity (mean difference 0.226 × 10
−4
min
−1
[pmol/l]
−1
[95% CI 0.104, 0.348];
p
< 0.001) and disposition index in pregnancies after RYGB when compared with obese control women. However, subtle alterations in insulin action and beta cell function were still observed when comparing women who had undergone RYGB with the normal-weight control group. Moreover, we observed that fetal growth was associated with maternal glucose nadir levels and insulin secretion in offspring of those who had previously undergone RYGB.
Conclusions/interpretation
Pregnancies after RYGB are affected by altered postprandial glucose, insulin and C-peptide dynamics. Insulin sensitivity is improved by RYGB, although subtle alterations in beta cell function are observed. Longitudinal studies are needed to assess potential consequences for fetal development and pregnancy outcomes.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>28918470</pmid><doi>10.1007/s00125-017-4437-6</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Diabetologia, 2017-12, Vol.60 (12), p.2504-2513 |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Beta cells Blood Glucose - metabolism C-Peptide - metabolism Female Fetuses Gastric Bypass Gastrointestinal surgery Gestation Glucagon Glucose Glucose - metabolism Glucose Tolerance Test Human Physiology Humans Hypoglycemia Insulin Insulin - metabolism Insulin secretion Internal Medicine Medicine Medicine & Public Health Metabolic Diseases Metabolism Obesity - metabolism Pregnancy Prospective Studies Secretion Surgery |
| title | Assessment of glucose regulation in pregnancy after gastric bypass surgery |
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