Katsogiannos Petros, Kamble Prasad G, Wiklund Urban, Sundbom Magnus, Espes Daniel, Hammar Ulf, Karlsson F Anders, Pereira Maria J, Eriksson Jan W
Department of Medical Science, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden.
Radiation Sciences, Biomedical Engineering & Informatics, Umeå University, Umeå, Sweden.
Endocrine. 2020 Feb;67(2):344-353. doi: 10.1007/s12020-020-02203-w. Epub 2020 Jan 26.
To explore the role of hormones and the autonomic nervous system in the rapid remission of diabetes after Roux-en-Y Gastric Bypass (RYGB).
Nineteen obese patients with type 2 diabetes, 7 M/12 F, were randomized (2:1) to RYGB or standard-of-care medical treatment (control). At baseline and 4 and 24 weeks post surgery, fasting blood sampling, OGTT, intravenous arginine challenge, and heart-rate variability (HRV) assessments were performed.
At both 4 and 24 weeks post-RYGB the following effects were found: arginine-stimulated insulin secretion was reduced. GLP-1, GIP, and glucagon rise during OGTT was enhanced. IGF-1 and GH levels increased. In addition, total HRV and spectral components P (power of low frequency) and P (power of high frequency) increased. At 4 weeks, morning cortisol was lower than baseline and 24 weeks. At 24 weeks, NEFA levels during OGTT, and the P/P ratio decreased. None of these changes were seen in the control group.
There were rapid changes within 4 weeks after RYGB: signs of enhanced parasympathetic nerve activity, reduced morning cortisol, and enhanced incretin and glucagon responses to glucose. The findings suggest that neurohormonal mechanisms can contribute to the rapid improvement of insulin resistance and glycemia following RYGB in type 2 diabetes.
探讨激素和自主神经系统在Roux-en-Y胃旁路术（RYGB）后糖尿病快速缓解中的作用。
19例肥胖2型糖尿病患者，7例男性/12例女性，随机（2:1）分为RYGB组或标准医疗治疗组（对照组）。在基线、术后4周和24周时，进行空腹采血、口服葡萄糖耐量试验（OGTT）、静脉注射精氨酸激发试验以及心率变异性（HRV）评估。
RYGB术后4周和24周均发现以下效应：精氨酸刺激的胰岛素分泌减少。OGTT期间胰高血糖素样肽-1（GLP-1）、葡萄糖依赖性促胰岛素多肽（GIP）和胰高血糖素升高增强。胰岛素样生长因子-1（IGF-1）和生长激素（GH）水平升高。此外，总HRV以及频谱成分低频功率（P）和高频功率（P）增加。术后4周，早晨皮质醇低于基线水平和术后24周。术后24周，OGTT期间非酯化脂肪酸（NEFA）水平以及P/P比值降低。对照组未出现这些变化。
RYGB术后4周内出现快速变化：副交感神经活动增强、早晨皮质醇降低以及肠促胰岛素和胰高血糖素对葡萄糖的反应增强。这些发现表明，神经激素机制可能有助于2型糖尿病患者RYGB术后胰岛素抵抗和血糖的快速改善。
