MD, Department of Clinical and Experimental Medicine, Via Roma 67, 56100 Pisa, Italy.
J Clin Endocrinol Metab. 2013 Nov;98(11):4391-9. doi: 10.1210/jc.2013-2538. Epub 2013 Sep 20.
In obese patients with type 2 diabetes (T2DM), Roux-en-Y-gastric-bypass (RYGB) and sleeve gastrectomy (SLG) improve glycemic control.
The objective of this study was to investigate the mechanisms of surgery-induced T2DM improvement and role of gastrointestinal hormones. PATIENTS, SETTING, AND INTERVENTION: In 35 patients with T2DM, we performed a mixed-meal test before and 15 days and 1 year after surgery (23 RYGB and 12 SLG).
Insulin sensitivity, β-cell function, and amylin, ghrelin, PYY, pancreatic polypeptide (PP), glucagon, and glucagon-like peptide-1 (GLP-1) responses to the meal were measured.
T2DM remission occurred in 13 patients undergoing RYGB and in 7 patients undergoing SLG. Similarly in the RYGB and SLG groups, β-cell glucose sensitivity improved both early and long term (P < .005), whereas insulin sensitivity improved long term only (P < .006), in proportion to body mass index changes (P < .001). Early after RYGB, glucagon and GLP-1 responses to the meal increased, whereas the PP response decreased. At 1 year, PYY was increased, and PP, amylin, ghrelin, and GLP-1 were reduced. After SLG, hormonal responses were similar to those with RYGB except that PP was increased, whereas amylin was unchanged. In remitters, fasting GLP-1 was higher (P = .04), but its meal response was flat compared with that of nonremitters; postsurgery, however, the GLP-1 response was higher. Other hormone responses were similar between the 2 groups. In logistic regression, presurgery β-cell glucose sensitivity (positive, P < .0001) and meal-stimulated GLP-1 response (negative, P = .004) were the only predictors of remission.
RYGB and SLG have a similar impact on diabetes remission, of which baseline β-cell glucose sensitivity and a restored GLP-1 response are the chief determinants. Other hormonal responses are the consequences of the altered gastrointestinal anatomy.
在患有 2 型糖尿病（T2DM）的肥胖患者中，Roux-en-Y 胃旁路术（RYGB）和袖状胃切除术（SLG）均可改善血糖控制。
本研究旨在探讨手术改善 T2DM 的机制及胃肠激素的作用。
患者、设置和干预：35 例 T2DM 患者分别在术前及术后 15 天和 1 年进行混合餐试验（23 例行 RYGB，12 例行 SLG）。
测量胰岛素敏感性、β细胞功能以及胰岛素、胰淀素、胃饥饿素、肽 YY（PYY）、胰多肽（PP）、胰高血糖素和胰高血糖素样肽-1（GLP-1）对餐食的反应。
RYGB 组 13 例和 SLG 组 7 例患者糖尿病缓解。RYGB 组和 SLG 组患者的β细胞葡萄糖敏感性均在早期和长期改善（P＜0.005），而胰岛素敏感性仅在长期改善（P＜0.006），与体重指数变化成比例（P＜0.001）。RYGB 术后早期，胰高血糖素和 GLP-1 对餐食的反应增加，而 PP 反应减少。术后 1 年，PYY 增加，PP、胰淀素、胃饥饿素和 GLP-1 减少。SLG 后，激素反应与 RYGB 相似，只是 PP 增加，而胰淀素不变。在缓解者中，空腹 GLP-1 较高（P=0.04），但与未缓解者相比，其餐后反应平坦；然而，术后 GLP-1 反应更高。两组间其他激素反应相似。在逻辑回归中，术前β细胞葡萄糖敏感性（阳性，P＜0.0001）和餐后 GLP-1 反应（阴性，P=0.004）是缓解的唯一预测因素。
RYGB 和 SLG 对糖尿病缓解的影响相似，其中基线β细胞葡萄糖敏感性和恢复的 GLP-1 反应是主要决定因素。其他激素反应是改变胃肠解剖结构的结果。
