Limited recovery of β-cell function after gastric bypass despite clinical diabetes remission

  1. Blandine Laferrère1,2,3,7
  1. 1Department of Medicine
  2. 2New York Obesity Nutrition Research Center
  3. 3Division of Endocrinology and Diabetes
  4. 4Division of Minimally Invasive Surgery, Department of Surgery, St. Luke’s Roosevelt Hospital Center, New York, NY, USA
  5. 5Department of Medicine, Albert Einstein School of Medicine, New York, NY, USA
  6. 6Department of Medicine, Centre de Recherche Clinique Etienne-Le Bel, Université de Sherbrooke, Sherbrooke, Quebec, CANADA
  7. 7Columbia University College of Physicians and Surgeons, New York, NY, USA
  1. Corresponding author: Blandine Laferrère E-mail: BBL14{at}columbia.edu

Abstract

The mechanisms responsible for the remarkable remission of type 2 diabetes after Roux-en Y gastric bypass (RYGBP) are still puzzling. To elucidate the role of the gut, we compared β-cell function assessed during an oral glucose tolerance test (OGTT) and an isoglycemic intravenous glucose clamp (iso-IVGC) in: 1) 16 severely obese patients with type 2 diabetes, up to 3 years post-RYGBP (OB-DM); 2) 11 severely obese normal glucose tolerant controls (OB-NGT); 3) 7 LEAN controls. Diabetes remission was observed after RYGBP. β-cell function during the OGTT, significantly blunted prior to RYGBP, normalized to levels of both control groups after RYGBP. In contrast, during the iso-IVGC, β-cell function improved minimally and remained significantly impaired compared to LEAN controls up to 3 years post-RYGBP. Pre-surgery β-cell function, weight loss and GLP-1 response were all predictors of post-surgery β-cell function, although weight loss appeared to be the strongest predictor. These data show that β-cell dysfunction persists after RYGBP, even in patients in clinical diabetes remission. This impairment can be rescued by oral glucose stimulation, suggesting that RYGBP leads to an important gastrointestinal effect, critical for improved β-cell function after surgery.

  • Received August 1, 2013.
  • Accepted November 22, 2013.

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