Roux-en-Y gastric bypass compared with equivalent diet restriction: Mechanistic insights into diabetes remission

Laurentiu M. Pop, Andrea Mari, Tong Jin Zhao, Lori Mitchell, Shawn Burgess, Xilong Li, Beverley Adams-Huet, Ildiko Lingvay

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Aims: To investigate the physiological mechanisms leading to rapid improvement in diabetes after Roux-en-Y gastric bypass (RYGB) and specifically the contribution of the concurrent peri-operative dietary restrictions, which may also alter glucose metabolism. Materials and methods: In order to assess the differential contributions of diet and surgery to the mechanisms leading to the rapid improvement in diabetes after RYGB we enrolled 10 patients with type 2 diabetes scheduled to undergo RYGB. All patients underwent a 10-day inpatient supervised dietary intervention equivalent to the peri-operative diet (diet-only period), followed by, after a re-equilibration (washout) period, an identical period of pair-matched diet in conjunction with RYGB (diet and RYGB period). We conducted extensive metabolic assessments during a 6-hour mixed-meal challenge test, with stable isotope glucose tracer infusion performed before and after each intervention. Results: Similar improvements in glucose levels, β-cell function, insulin sensitivity and post-meal hepatic insulin resistance were observed with both interventions. Both interventions led to significant reductions in fasting and postprandial acyl ghrelin. The diet-only intervention induced greater improvements in basal hepatic glucose output and post-meal gastric inhibitory polypeptide (GIP) secretion. The diet and RYGB intervention induced significantly greater increases in post-meal glucagon-like peptide-1 (GLP-1), peptide YY (PYY) and glucagon levels. Conclusions: Strict peri-operative dietary restriction is a main contributor to the rapid improvement in glucose metabolism after RYGB. The RYGB-induced changes in the incretin hormones GLP-1 and PYY probably play a major role in long-term compliance with such major dietary restrictions through central and peripheral mechanisms.

Original languageEnglish (US)
Pages (from-to)1710-1721
Number of pages12
JournalDiabetes, Obesity and Metabolism
Volume20
Issue number7
DOIs
StatePublished - Jul 2018

Keywords

  • diabetes remission
  • diet restriction
  • gastric bypass surgery
  • glycaemic control

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Pop, L. M., Mari, A., Zhao, T. J., Mitchell, L., Burgess, S., Li, X., Adams-Huet, B., & Lingvay, I. (2018). Roux-en-Y gastric bypass compared with equivalent diet restriction: Mechanistic insights into diabetes remission. Diabetes, Obesity and Metabolism, 20(7), 1710-1721. https://doi.org/10.1111/dom.13287