Effects of different metabolic states and surgical models on glucose metabolism and secretion of ileal L‐cell peptides: results from the HIPER‐1 study. Issue 4 (15th December 2019)

• Record Type: Journal Article
• Authors: Cagiltay, E.; Celik, A.; Dixon, J. B.; Pouwels, S.; Santoro, S.; Gupta, A.; Ugale, S.; Abdul‐Ghani, M.
• Is Part Of: Diabetic medicine. Volume 37:Issue 4(2020)
• Page Start: 697
• Page End: 704
• Publication Date: 2019-12-15
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.14191
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aim: To compare the impact of four surgical procedures (mini‐gastric bypass, sleeve gastrectomy, ileal transposition and transit bipartition) vs medical management on gut peptide secretion, β‐cell function and resolution of hyperglycaemia in people with type 2 diabetes. Research design and methods: A mixed‐meal tolerance test was administered 6–24 months after each surgical procedure (mini‐gastric bypass, sleeve gastrectomy, ileal transposition and transit bipartition; n=30 in each group) and the results were compared with those obtained in matched lean (n=30) and obese (n=30) people with type 2 diabetes undergoing medical management. Results: Participants in the mini‐gastric bypass and ileal transposition groups had a greater increase in plasma glucose concentration after the mixed‐meal tolerance test than those in the sleeve gastrectomy and transit bipartition groups. Participants in the mini‐gastric bypass group exhibited the greatest increase in the incremental area under the curve of plasma glucose concentration above baseline (P<0.0001). Insulin sensitivity was similar across surgical groups, and statistically greater in participants in the surgical groups than in obese participants in the non‐surgical group (P<0.0001). β‐cell responsiveness to glucose was greater in participants in the sleeve gastrectomy and transit bipartition groups than in the mini‐gastric bypass and ileal transposition groups (P<0.001) despite a smaller incremental increase above baseline in the area under the plasma glucagon‐like peptide‐1 concentration curve relative to ileal transposition. Postoperative β‐cell function was the strongest predictor of hyperglycaemia resolution. Conclusions: The present study showed that the level of β‐cell function after bariatric surgery is the strongest predictor of hyperglycaemia resolution. The study also demonstrates a disconnect between postprandial GLP‐1 levels and β‐cell function among the studied surgical procedures. What's new?: The effects of four different surgical procedures (one‐anastomosis mini‐gastric bypass, sleeve gastrectomy, ileal transposition and transit bipartition])were compared with those of medical management on gut peptide secretion, β‐cell function and resolution of hyperglycaemia in participants with type 2 diabetes mellitus. The level of β‐cell function after bariatric surgery was the strongest predictor of hyperglycaemia resolution. There is a disconnect between postprandial glucagon‐like peptide‐1 levels and β‐cell function between the studied surgical procedures.