Matched weight loss induced by sleeve gastrectomy or gastric bypass similarly improves metabolic function in obese subjects

David Bradley, Faidon Magkos, J Christopher Eagon, J Esteban Varela, Amalia Gastaldelli, Adewole L Okunade, Bruce W Patterson, Samuel Klein, David Bradley, Faidon Magkos, J Christopher Eagon, J Esteban Varela, Amalia Gastaldelli, Adewole L Okunade, Bruce W Patterson, Samuel Klein

Abstract

Objective: The effects of marked weight loss, induced by Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgeries, on insulin sensitivity, β-cell function and the metabolic response to a mixed meal were evaluated.

Methods: Fourteen nondiabetic insulin-resistant patients who were scheduled to undergo SG (n = 7) or RYGB (n = 7) procedures completed a hyperinsulinemic-euglycemic clamp procedure and a mixed-meal tolerance test before surgery and after losing ∼20% of their initial body weight.

Results: Insulin sensitivity (insulin-stimulated glucose disposal during a clamp procedure), oral glucose tolerance (postprandial plasma glucose area under the curve), and β-cell function (insulin secretion in relationship to insulin sensitivity) improved after weight loss, and were not different between surgical groups. The metabolic response to meal ingestion was similar after RYGB or SG, manifested by rapid delivery of ingested glucose into the systemic circulation and a large early postprandial increase in plasma glucose, insulin, and C-peptide concentrations in both groups.

Conclusions: When matched on weight loss, RYGB and SG surgeries result in similar improvements in the two major factors involved in regulating plasma glucose homeostasis, insulin sensitivity and β-cell function in obese people without diabetes.

Trial registration: ClinicalTrials.gov NCT00981500.

Conflict of interest statement

Conflicts of Interest: SK is a shareholder of Aspire Bariatrics, Metro Midwest Biotech and Human Longevity Inc, serves as a consultant for Aspire Bariatrics, served on the scientific advisory boards of Takeda Pharmaceuticals, Vivus, Danone/Yakult, Bristol-Myers Squibb, NovoNordisk, Dairy Research Institute, and the Egg Nutrition Council, and is a member of the Merck Speakers Bureau.

© 2014 The Obesity Society.

Figures

Figure 1
Figure 1
Insulin-stimulated glucose disposal (assessed by using the hyperinsulinemic-euglycemic clamp procedure) (A) and β-cell function (based on the relationship between insulin secretion during a mixed meal and insulin sensitivity) (B) before (white bars) and after (black bars) ∼20% weight loss induced by Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgeries. *Value significantly different from value before surgery, p

Figure 2

Plasma hormone concentrations after ingestion…

Figure 2

Plasma hormone concentrations after ingestion of a mixed meal (consumed from 0-30 min)…

Figure 2
Plasma hormone concentrations after ingestion of a mixed meal (consumed from 0-30 min) before (white circles) and after (black squares) ∼20% weight loss induced by roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgeries. Plasma glucose, insulin and C-peptide concentrations areas under the curve were significantly different after than before surgery in both RYGB and SG groups (all p-values 0.42). Values are means±SEM.

Figure 3

Rate of appearance (Ra) of…

Figure 3

Rate of appearance (Ra) of ingested glucose into the systemic circulation, ingested glucose…

Figure 3
Rate of appearance (Ra) of ingested glucose into the systemic circulation, ingested glucose Ra as a percentage of total glucose Ra, rate of endogenous glucose production (EGP), and EGP as a percentage of total glucose Ra after ingestion of a mixed meal (consumed from time 0-30 min) before (white circles) and after (black squares) ∼20% weight loss induced by Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgeries. The changes in ingested glucose Ra and EGP after surgery were not different between RYGB and SG groups (all p-values for interaction >0.25). Values are means±SEM.
Figure 2
Figure 2
Plasma hormone concentrations after ingestion of a mixed meal (consumed from 0-30 min) before (white circles) and after (black squares) ∼20% weight loss induced by roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgeries. Plasma glucose, insulin and C-peptide concentrations areas under the curve were significantly different after than before surgery in both RYGB and SG groups (all p-values 0.42). Values are means±SEM.
Figure 3
Figure 3
Rate of appearance (Ra) of ingested glucose into the systemic circulation, ingested glucose Ra as a percentage of total glucose Ra, rate of endogenous glucose production (EGP), and EGP as a percentage of total glucose Ra after ingestion of a mixed meal (consumed from time 0-30 min) before (white circles) and after (black squares) ∼20% weight loss induced by Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgeries. The changes in ingested glucose Ra and EGP after surgery were not different between RYGB and SG groups (all p-values for interaction >0.25). Values are means±SEM.

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