Glucose metabolism and production of incretins in patients with obesity and type 2 diabetes mellitus after Biliopancreatic bypass surgery in the modification of Hess-Marceau the early stages of postoperative monitoring

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Abstract


Introduction: a significant improvement was shown in metabolic control at the early stages after BPD, which was associated with GLP-1 and was regardless of weight loss.

Aim: to study the secretion of GLP-1, GIP, insulin and glucagon and their relationship to the parameters of the carbohydrate metabolism among patients with obesity and type 2 diabetes before and 3 months after BPD.

Materials and Methods: the check-up involved 22 patients with obesity (BMI 50.1 [41.3; 53.8] kg/m²) and type 2 diabetes. Determined: glucose, HbA1c, insulin, glucagon, GLP-1, GIP.

Results: after the surgery for weight loss of 15.8% was showed a reduction of fasting and postprandial glycemia, a reduction of AUCglucose, HbA1c, НОМА-IR and hyperinsulinemia. The secretion of GLP-1 with a peak at 30' (test with a standard breakfast) increased, AUCGLP-1 – to 1.8-fold, the basal secretion of GIP – almost 2-fold and AUCGIP – to 1.7-fold; decreased of a secretion of glucagon with a minimum at 60' and AUCglucagon. A negative correlation was revealed between GIP and glucagon, AUCglucose and AUCglucagon; a positive correlation was revealed between GLP-1 and insulin. The weight loss was accompanied by an inversely proportional increase of GLP-1.

Conclusion: More than 90% of the surveyed patients achieved a satisfactory glycemic control as early as 3 months after BPD. The significant improvement of the parameters of the carbohydrate metabolism was associated with elevated levels of GLP-1 and this improvement does not depend of weight loss. 


About the authors

Ivan Ivanovich Dedov

Endocrinology Research Centre

Email: libr@endocrincentr.ru

Russian Federation MD, Ph.D, academician of the Russian Academy of Sciences, Director

Ekaterina Anatol'evna Troshina

Endocrinology Research Centre

Email: troshina@inbox.ru

Russian Federation MD, Ph.D. Professor, Head of the  Therapy Department with a group of obesity

Ekaterina Vladimirovna Ershova

Endocrinology Research Centre

Author for correspondence.
Email: yu99pol06@rambler.ru

Russian Federation researcher at the the  Therapy Department with a group of obesity

Yuriy Ivanovich Yashkov

Center of Endosurgery and Lithotripsy

Email: yu@yashkov.ru

Russian Federation MD, Ph.D. Professor, surgeon. President of the European Federation of obesity surgery and metabolic disorders (IFSO-EU Chapter) in 2012-2014

References

  1. Mason EE. The Mechanisms of Surgical Treatment of Type 2 Diabetes. Obesity Surgery. 2005;15(4):459–61. PMID:15946422 doi: 10.1381/0960892053723330.
  2. Яшков Ю.И. Возможности коррекции нарушений углеводного обмена при сахарном диабете 2 типа с применением бариатрических операций. // Сахарный диабет. - 2000. - Т.3. - №2 - С. 26-29. [Yashkov YI. Vozmozhnosti
  3. korrektsii narusheniy uglevodnogo obmena pri sakharnom diabete 2 tipa
  4. s primeneniem bariatricheskikh operatsiy. Diabetes mellitus. 2000;3(2):26–29.
  5. doi: 10.14341/2072-0351-5883].
  6. Pories WJ, Dohm GL. Full and durable remission of type 2 diabetes? Through surgery? Surgery for Obesity and Related Diseases. 2009;5(2):285–8. PMID:19250882 doi: 10.1016/j.soard.2008.12.006.
  7. Drucker DJ. The biology of incretin hormones. Cell Metabolism. 2006;3(3):153–65. PMID:16517403 doi: 10.1016/j.cmet.2006.01.004.
  8. Holst J, Vilsboll T, Deacon C. The incretin system and its role in type 2 diabetes mellitus. Molecular and Cellular Endocrinology. 2009;297(1–2):127–36. PMID:18786605 doi: 10.1016/j.mce.2008.08.012.
  9. Дедов И.И., Яшков Ю.И., Ершова Е.В. Инкретины и их влияние на течение сахарного диабета 2 типа у пациентов с морбидным ожирением после бариатрических операций. // Ожирение и метаболизм. – 2012. – №. 2. – С. 3–10. [Dedov II, Yashkov YI, Ershova EV. Incretins and their influence on the course of type 2 diabetes in patients with morbid obesity after bariatric oper. Obesity and metabolism. 2012;(2):3–10. doi: 10.14341/omet201223-10]
  10. Elrick H, Stimmler L, Hlad CJ, Arai Y. Plasma Insulin Response to Oral and Intravenous Glucose Administration1. The Journal of Clinical Endocrinology & Metabolism. 1964;24(10):1076–82. PMID:14228531 doi: 10.1210/jcem-24-10-1076.
  11. Perley MJ, Kipnis DM. Plasma Insulin Responses to Oral and Intravenous Glucose: Studies in Normal and Diabetic Subjects*. Journal of Clinical Investigation. 1967;46(12):1954–62. PMID:6074000 doi: 10.1172/jci105685.
  12. Огнева Н.А. Изменение продукции инкретинов и обмена кальция у пациентов с морбидным ожирением, перенесших билиопанкреатическое шунтирование: Дис. ... канд. мед. наук. – Москва: ФГБУ ЭНЦ, 2014. [Ogneva NA. Izmenenie produkcii inkretinov i obmena kal'cija u pacientov s morbidnym ozhireniem, perenesshih biliopankreaticheskoe shuntirovanie: [dissertation]. – Moscow: 2014.(In Russ)]
  13. Шестакова Е.А. Изучение факторов, влияющих на секрецию инкретинов, у лиц с различными нарушениями углеводного обмена: Дис. ... канд. мед. наук. – Москва: ФГБУ ЭНЦ, 2014. [Shestakova E.A. Izuchenie faktorov, vlijajushhih na sekreciju inkretinov, u lic s razlichnymi narushenijami uglevodnogo obmena: [dissertation]. – Moscow: 2014. (In Russ)]
  14. Baggio LL, Drucker DJ. Biology of Incretins: GLP-1 and GIP. Gastroenterology. 2007;132(6):2131–57. PMID:17498508 doi: 10.1053/j.gastro.2007.03.054.
  15. Nauck M, Stöckmann F, Ebert R, Creutzfeldt W. Reduced incretin effect in Type 2 (non-insulin-dependent) diabetes. Diabetologia. 1986;29(1):46–52. PMID:3514343 doi: 10.1007/bf02427280.
  16. Vilsbøll T, Knop FK, Krarup T, Johansen A, Madsbad S, Larsen S, et al. The Pathophysiology of Diabetes Involves a Defective Amplification of the Late-Phase Insulin Response to Glucose by Glucose-Dependent Insulinotropic Polypeptide—Regardless of Etiology and Phenotype. The Journal of Clinical Endocrinology & Metabolism. 2003;88(10):4897–903. PMID:14557471 doi: 10.1210/jc.2003-030738.
  17. Knop FK, Vilsbøll T, Madsbad S, Holst JJ, Krarup T. Inappropriate suppression of glucagon during OGTT but not during isoglycaemic i.v. glucose infusion contributes to the reduced incretin effect in type 2 diabetes mellitus. Diabetologia. 2007;50(4):797–805. PMID:17225124 doi: 10.1007/s00125-006-0566-z.
  18. Færch K, Vaag A, Holst JJ, Glümer C, Pedersen O, Borch-Johnsen K. Impaired fasting glycaemia vs impaired glucose tolerance: similar impairment of pancreatic alpha and beta cell function but differential roles of incretin hormones and insulin action. Diabetologia. 2008;51(5):853–61. PMID:18317726 doi: 10.1007/s00125-008-0951-x.
  19. Ершова Е.В., Яшков Ю.И. Состояние углеводного и липидного обмена у пациентов с ожирением и сахарным диабетом 2 типа после билиопанкреатического шунтирования. // Ожирение и метаболизм. – 2013. – №.3. – С. 28–36.Ershova EV, Yashkov YI. Status of carbohydrate and lipid metabolism in obese patients with type 2 diabetes mellitus after biliopancreatic diversion surgery. Obesity and metabolism. 2013;(3):28–36. doi: 10.14341/2071-8713-3862]
  20. Mannucci E., Tesi F., Bardini G. et al. Effects of metformin on glucagon-like peptide-1 levels in obese patients with and without Type 2 diabetes. Diabetes Nutr Metab. 2004; 17(6): 336–42. PMID:15887627
  21. Qualmann C, Nauck MA, Holst JJ, øSrskov C, Creutzfeldt W. Glucagon-like Peptide 1 (7–36 hide) Secretion in Response to Luminal Sucrose from the Upper and Lower Gut: A Study Using α-Glucosidase Inhibition (Acarbose). Scandinavian Journal of Gastroenterology. 1995;30(9):892–6. doi: 10.3109/00365529509101597.
  22. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. 6-е издание/ Под ред. Дедова И.И., Шестаковой М.В. – М, 2013. [Algoritmy specializirovannoj medicinskoj pomoshhi bol'nym saharnym diabetom. 6th edition. Ed by Dedov I.I., Shestakova M.V. Moscow; 2013.]
  23. Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C. Endocrine and Nutritional Management of the Post-Bariatric Surgery Patient: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. 2010;95(11):4823–43. PMID:21051578 doi: 10.1210/jc.2009-2128.
  24. IDF taskforce on the epidemiology and prevention, 2011
  25. Laferrère B, Teixeira J, McGinty J, Tran H, Egger JR, Colarusso A, et al. Effect of Weight Loss by Gastric Bypass SurgeryVersusHypocaloric Diet on Glucose and Incretin Levels in Patients with Type 2 Diabetes. The Journal of Clinical Endocrinology & Metabolism. 2008;93(7):2479–85. PMID:18430778 doi: 10.1210/jc.2007-2851.
  26. Valverde I, Puente J, Martín-Duce A, Molina L, Lozano O, Sancho V, et al. Changes in Glucagon-like Peptide-1 (GLP-1) Secretion after Biliopancreatic Diversion or Vertical Banded Gastroplasty in Obese Subjects. Obesity Surgery. 2005;15(3):387–97. PMID:15826475 doi: 10.1381/0960892053576613.
  27. Vilsbøll T, Krarup T, Sonne J, Madsbad S, Vølund A, Juul AG, et al. Incretin Secretion in Relation to Meal Size and Body Weight in Healthy Subjects and People with Type 1 and Type 2 Diabetes Mellitus. The Journal of Clinical Endocrinology & Metabolism. 2003;88(6):2706–13. PMID:12788877 doi: 10.1210/jc.2002-021873.
  28. Fujita Y, Wideman RD, Asadi A, Yang GK, Baker R, Webber T, et al. Glucose-Dependent Insulinotropic Polypeptide Is Expressed in Pancreatic Islet α-Cells and Promotes Insulin Secretion. Gastroenterology. 2010;138(5):1966–75.e1. PMID:20138041 doi: 10.1053/j.gastro.2010.01.049.
  29. Яшков Ю.И., Ершова Е.В. «Метаболическая» хирургия. // Ожирение и метаболизм. – 2011. – №. 3. – С. 13–17. [Yashkov YI, Ershova EV. «Metabolicheskaya» khirurgiya. Obesity and metabolism. 2011;(3):13–17. doi: 10.14341/2071-8713-4831]

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