Gastrointestinal Hormones and β-Cell Function After Gastric Bypass and Sleeve Gastrectomy: A Randomized Controlled Trial (Oseberg)

J Clin Endocrinol Metab. 2022 Jan 18;107(2):e756-e766. doi: 10.1210/clinem/dgab643.

Abstract

Context: Whether Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differentially affect postprandial gastrointestinal hormones and β-cell function in type 2 diabetes remains unclear.

Objective: We aimed to compare gastrointestinal hormones and β-cell function, assessed by an oral glucose tolerance test (OGTT) 5 weeks and 1 year after surgery, hypothesizing higher glucagon-like peptide-1 (GLP-1) levels and greater β-cell response to glucose after RYGB than after SG.

Methods: This study was a randomized, triple-blind, single-center trial at a tertiary care center in Norway. The primary outcomes were diabetes remission and IVGTT-derived β-cell function. Participants with obesity and type 2 diabetes were allocated (1:1) to RYGB or SG. We measured gastrointestinal hormone profiles and insulin secretion as β-cell glucose sensitivity (β-GS) derived from 180-minute OGTTs.

Results: Participants were 106 patients (67% women), mean (SD) age 48 (10) years. Diabetes remission rates at 1 year were higher after RYGB than after SG (77% vs 48%; P = 0.002). Incremental area under the curve (iAUC0-180) GLP-1 and β-GS increased more after RYGB than after SG, with 1-year between-group difference 1173 pmol/L*min (95% CI, 569-1776; P = 0.0010) and 0.45 pmol/kg/min/mmol (95% CI, 0.15-0.75; P = 0.0032), respectively. After surgery, fasting and postprandial ghrelin levels were higher and decremental AUC0-180 ghrelin, iAUC0-180 glucose-dependent insulinotropic polypeptide, and iAUC0-60 glucagon were greater after RYGB than after SG. Diabetes remission at 1 year was associated with higher β-GS and higher GLP-1 secretion.

Conclusion: RYGB was associated with greater improvement in β-cell function and higher postprandial GLP-1 levels than SG.

Trial registration: ClinicalTrials.gov NCT01778738.

Keywords: gastric bypass; gastrointestinal hormones; glucagon-like peptide 1; obesity; sleeve gastrectomy; type 2 diabetes.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / metabolism*
  • Female
  • Follow-Up Studies
  • Gastrectomy / methods
  • Gastrectomy / statistics & numerical data*
  • Gastric Bypass / methods
  • Gastric Bypass / statistics & numerical data*
  • Glucagon-Like Peptide 1 / blood*
  • Glucose Tolerance Test
  • Humans
  • Insulin / metabolism
  • Insulin-Secreting Cells / metabolism*
  • Male
  • Middle Aged
  • Obesity, Morbid / blood
  • Obesity, Morbid / metabolism
  • Obesity, Morbid / surgery*
  • Postprandial Period
  • Treatment Outcome

Substances

  • Blood Glucose
  • Insulin
  • Glucagon-Like Peptide 1

Associated data

  • ClinicalTrials.gov/NCT01778738