Differential effect of gastric bypass versus sleeve gastrectomy on insulinotropic action of endogenous incretins
This article relates to:
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Insulinotropic effect of endogenously secreted incretins after gastric bypass and sleeve gastrectomy
- Volume 31Issue 11Obesity
- pages: 2723-2724
- First Published online: October 19, 2023
Corresponding Author
Marzieh Salehi
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
Correspondence
Marzieh Salehi, Division of Diabetes, Department of Medicine, University of Texas Health at San Antonio, 7703 Floyd Curl Dr., mail code 7886, San Antonio, TX 78229, USA.
Email: [email protected]
Search for more papers by this authorRichard Peterson
Department of Surgery, University of Texas Health at San Antonio, San Antonio, Texas, USA
Search for more papers by this authorDevjit Tripathy
Division of Diabetes, Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas, USA
Search for more papers by this authorSamantha Pezzica
Cardiometabolic Risk Unit, CNR Institute of Clinical Physiology, Pisa, Italy
Search for more papers by this authorRalph DeFronzo
Division of Diabetes, Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas, USA
Search for more papers by this authorAmalia Gastaldelli
Division of Diabetes, Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas, USA
Cardiometabolic Risk Unit, CNR Institute of Clinical Physiology, Pisa, Italy
Search for more papers by this authorCorresponding Author
Marzieh Salehi
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
Correspondence
Marzieh Salehi, Division of Diabetes, Department of Medicine, University of Texas Health at San Antonio, 7703 Floyd Curl Dr., mail code 7886, San Antonio, TX 78229, USA.
Email: [email protected]
Search for more papers by this authorRichard Peterson
Department of Surgery, University of Texas Health at San Antonio, San Antonio, Texas, USA
Search for more papers by this authorDevjit Tripathy
Division of Diabetes, Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas, USA
Search for more papers by this authorSamantha Pezzica
Cardiometabolic Risk Unit, CNR Institute of Clinical Physiology, Pisa, Italy
Search for more papers by this authorRalph DeFronzo
Division of Diabetes, Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas, USA
Search for more papers by this authorAmalia Gastaldelli
Division of Diabetes, Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas, USA
Cardiometabolic Risk Unit, CNR Institute of Clinical Physiology, Pisa, Italy
Search for more papers by this authorAbstract
Objective
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.
Methods
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.
Results
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.
Conclusions
After GB, increasing incretin activity augments prandial β-cell response whereas the β-cell sensitivity to increasing plasma concentrations of endogenous incretin is diminished.
CONFLICT OF INTEREST STATEMENT
The authors declared no conflict of interest.
Supporting Information
| Filename | Description |
|---|---|
| oby23872-sup-0001-FigureS1.tifTIFF image, 876.1 KB | Figure S1. Plasma concentrations of acetaminophen after oral glucose ingestion during OGTT with (dashed line) and without (solid line) administration of sitagliptin in subjects who underwent gastric bypass (top panel) or sleeve gastrectomy (middle panel) and non-operated controls (bottom panel). |
| oby23872-sup-0002-FigureS2.tifTIFF image, 2.9 MB | Figure S2. The slope of post OGTT ISR plotted against increasing plasma concentrations of active GLP-1 (aGLP-1) (left), GIP (middle), and glucose (right) during control (solid line) and sitagliptin (dashed line) conditions in subjects who underwent gastric bypass (black line) or sleeve gastrectomy (red line) and non-operated controls (blue line). |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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