Division of Diabetes, Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas, USA.
South Texas Veteran Health Care System, Audie Murphy Hospital, San Antonio, Texas, USA.
Obesity (Silver Spring). 2023 Nov;31(11):2774-2785. doi: 10.1002/oby.23872.
Prandial hyperinsulinemia after Roux-en-Y gastric bypass surgery (GB), and to lesser degree after sleeve gastrectomy (SG), has been attributed to rapid glucose flux from the gut and increased insulinotropic gut hormones. However, β-cell sensitivity to exogenous incretin is reduced after GB. This study examines the effect of GB versus SG on prandial glycemia and β-cell response to increasing concentrations of endogenous incretins.
Glucose kinetics, insulin secretion rate (ISR), and incretin responses to 50-g oral glucose ingestion were compared between ten nondiabetic participants with GB versus nine matched individuals with SG and seven nonoperated normal glucose tolerant control individuals (CN) with and without administration of 200 mg of sitagliptin.
Fasting glucose and hormonal levels were similar among three groups. Increasing plasma concentrations of endogenous incretins by two- to three-fold diminished prandial glycemia and increased β-cell secretion in all three groups (p < 0.05), but insulin secretion per insulin sensitivity (i.e., disposition index) was increased only in GB (p < 0.05 for interaction). However, plot of the slope of ISR (from premeal to peak values) versus plasma glucagon-like peptide-1 concentration was smaller after GB compared with SG and CN.
After GB, increasing incretin activity augments prandial β-cell response whereas the β-cell sensitivity to increasing plasma concentrations of endogenous incretin is diminished.
Roux-en-Y 胃旁路手术后（GB），以及程度较轻的袖状胃切除术（SG）后，餐后高胰岛素血症归因于肠道中葡萄糖的快速流动和增加的胰岛素促肠激素。然而，GB 后β细胞对外源肠促胰岛素的敏感性降低。本研究检查了 GB 与 SG 对餐后血糖和β细胞对增加浓度的内源性肠促胰岛素反应的影响。
比较了 10 名接受 GB 的非糖尿病参与者与 9 名接受 SG 的匹配个体以及 7 名未接受手术的正常糖耐量对照个体（CN）在口服 50g 葡萄糖后葡萄糖动力学、胰岛素分泌率（ISR）和肠促胰岛素反应。在接受和不接受 200mg 西他列汀治疗的情况下。
三组间空腹血糖和激素水平相似。三种情况下，内源性肠促胰岛素浓度增加两到三倍，均降低了餐后血糖并增加了β细胞分泌（p<0.05），但仅在 GB 中增加了胰岛素分泌对胰岛素敏感性（即处置指数）（p<0.05 交互作用）。然而，与 SG 和 CN 相比，GB 后 ISR（从餐前到峰值）斜率与胰高血糖素样肽-1浓度的关系图较小。
GB 后，增加肠促胰岛素活性增强了餐后β细胞反应，而β细胞对增加的内源性肠促胰岛素浓度的敏感性降低。
