Lips Mirjam A, de Groot Gerrit H, van Klinken Jan B, Aarts Edo, Berends Frits J, Janssen Ignace M, Van Ramshorst Bert, Van Wagensveld Bart A, Swank Dingeman J, Van Dielen Francois, Willems van Dijk Ko, Pijl Hanno
Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, The Netherlands.
Clin Endocrinol (Oxf). 2014 Jun;80(6):834-42. doi: 10.1111/cen.12254. Epub 2013 Jun 20.
Roux-en-Y gastric bypass (RYGB) and restrictive weight loss interventions, such as gastric banding (GB) and very-low-calorie diets (VLCD) directly impact glucose metabolism, possibly by calorie restriction and/or altered secretion of gut hormones. We aimed to establish the direct endocrine and metabolic effects of RYGB compared to restrictive interventions in obese glucose-tolerant (NGT) subjects and subjects with type 2 diabetes (T2DM).
Controlled, nonrandomized observational trial.
Four groups of obese females received a mixed meal at baseline and 3 weeks after intervention; NGT-GB (n = 11), NGT-RYGB (n = 16), T2DM-RYGB (n = 15) and T2DM-VLCD (n = 12). Normal weight controls (n = 12) were studied once.
At baseline, all obese subjects were hyperinsulinemic. T2DM was associated with hyperglycaemia and decreased GLP-1 levels. RYGB and VLCD reduced glucose levels to a similar extent in T2DM, insulin levels decreased only after VLCD. Comparison of restrictive intervention vs RYGB showed a more pronounced decrease in glucose and insulin AUC after restriction. In NGT and T2DM subjects, RYGB increased GLP-1 and PYY levels and decreased ghrelin levels, whereas VLCD and GB only increased GIP levels.
These data indicate that deterioration of glucose metabolism in T2DM is associated with a decline of GLP-1 levels. Calorie restriction facilitates glucose metabolism and blunts hyperinsulinemia in obese (diabetic) humans. Additional duodenal exclusion through RYGB induces gut hormone release and hyperinsulinemia but does not improve postprandial glucose levels any further. Our data thus strongly suggest that calorie restriction underlies the short-term metabolic benefits of RYGB in obese T2DM patients.
Roux-en-Y胃旁路术（RYGB）以及限制性减肥干预措施，如胃束带术（GB）和极低热量饮食（VLCD），可能通过热量限制和/或肠道激素分泌改变直接影响葡萄糖代谢。我们旨在确定与肥胖糖耐量正常（NGT）受试者和2型糖尿病（T2DM）受试者的限制性干预措施相比，RYGB的直接内分泌和代谢作用。
对照、非随机观察性试验。
四组肥胖女性在基线期和干预后3周接受混合餐；NGT-GB组（n = 11）、NGT-RYGB组（n = 16）、T2DM-RYGB组（n = 15）和T2DM-VLCD组（n = 12）。对体重正常的对照组（n = 12）进行了一次研究。
在基线期，所有肥胖受试者均存在高胰岛素血症。T2DM与高血糖和GLP-1水平降低有关。在T2DM患者中，RYGB和VLCD使血糖水平降低的程度相似，仅VLCD后胰岛素水平下降。限制性干预与RYGB的比较显示，限制后葡萄糖和胰岛素曲线下面积（AUC）下降更为明显。在NGT和T2DM受试者中，RYGB增加了GLP-1和PYY水平，降低了胃饥饿素水平，而VLCD和GB仅增加了GIP水平。
这些数据表明，T2DM患者葡萄糖代谢恶化与GLP-1水平下降有关。热量限制有助于肥胖（糖尿病）人群的葡萄糖代谢并减轻高胰岛素血症。通过RYGB额外进行十二指肠排除可诱导肠道激素释放和高胰岛素血症，但不会进一步改善餐后血糖水平。因此，我们的数据强烈表明，热量限制是RYGB对肥胖T2DM患者短期代谢益处的基础。
