GLP-1 and Glucose Tolerance After Sleeve Gastrectomy in Morbidly Obese Subjects with Type 2 Diabetes

  1. Josep Vidal1,2,4
  1. 1Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain.
  2. 2Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
  3. 3C.N.R. Institute of Biomedical Engineering, Padua, Italy.
  4. 4Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.
  5. 5Department of Clinical & Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy.
  1. Corresponding author: Josep Vidal, E-mail: jovidal{at}


Although GLP-1 has been suggested as a major factor for the marked improvement of glucose tolerance commonly seen after sleeve gastrectomy (SG), several observations challenge this hypothesis. To better understand the role of GLP-1 in the remission of T2DM long-term after SG in humans, we conducted two separate cross-sectional studies: (1) the GLP-1 response to a standardized mixed liquid meal (SMLM) was compared in subjects with T2DM antedating SG but with different long-term (>2 years) T2DM outcomes (remission, relapse, or lack of remission), and (2) the effect of GLP-1 receptor blockade with Exendin 9-39 on glucose tolerance was examined in subjects with T2DM antedating surgery, who had undergone SG and presented with long-term T2DM remission. In Study 1, we observed a comparable GLP-1 response to the SMLM regardless of the post-SG outcome of T2DM. In Study 2, the blockade of GLP-1 action resulted in impaired insulin secretion but limited deterioration of glucose tolerance. Thus, our data suggest the enhanced GLP-1 secretion observed long-term after SG is neither sufficient nor critical to maintain normal glucose tolerance in subjects with T2DM antedating the surgery.

  • Received February 28, 2014.
  • Accepted May 15, 2014.

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