Gastric Bypass and Banding Equally Improve Insulin Sensitivity and β Cell Function

J Clin Invest. 2012 Dec;122(12):4667-74. doi: 10.1172/JCI64895. Epub 2012 Nov 26.

Abstract

Bariatric surgery in obese patients is a highly effective method of preventing or resolving type 2 diabetes mellitus (T2DM); however, the remission rate is not the same among different surgical procedures. We compared the effects of 20% weight loss induced by laparoscopic adjustable gastric banding (LAGB) or Roux-en-Y gastric bypass (RYGB) surgery on the metabolic response to a mixed meal, insulin sensitivity, and β cell function in nondiabetic obese adults. The metabolic response to meal ingestion was markedly different after RYGB than after LAGB surgery, manifested by rapid delivery of ingested glucose into the systemic circulation, by an increase in the dynamic insulin secretion rate, and by large, early postprandial increases in plasma glucose, insulin, and glucagon-like peptide-1 concentrations in the RYGB group. However, the improvement in oral glucose tolerance, insulin sensitivity, and overall β cell function after weight loss were not different between surgical groups. Additionally, both surgical procedures resulted in a similar decrease in adipose tissue markers of inflammation. We conclude that marked weight loss itself is primarily responsible for the therapeutic effects of RYGB and LAGB on insulin sensitivity, β cell function, and oral glucose tolerance in nondiabetic obese adults.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Area Under Curve
  • Body Composition
  • CD11b Antigen / metabolism
  • Ceramides / metabolism
  • Cytokines / metabolism
  • Diglycerides / metabolism
  • Female
  • Gastric Bypass*
  • Gastroplasty*
  • Humans
  • Inflammation Mediators / metabolism
  • Insulin / metabolism
  • Insulin Resistance*
  • Insulin Secretion
  • Insulin-Secreting Cells / metabolism
  • Insulin-Secreting Cells / physiology*
  • Intra-Abdominal Fat / metabolism
  • Intra-Abdominal Fat / pathology
  • Male
  • Membrane Glycoproteins / metabolism
  • Middle Aged
  • Mucins / metabolism
  • Muscle, Skeletal / metabolism
  • Obesity / metabolism
  • Obesity / pathology
  • Obesity / surgery*
  • Organ Size
  • Postprandial Period
  • Receptors, G-Protein-Coupled / metabolism
  • Weight Loss

Substances

  • CD11b Antigen
  • Ceramides
  • Cytokines
  • Diglycerides
  • EMR1 protein, human
  • ITGAM protein, human
  • Inflammation Mediators
  • Insulin
  • Membrane Glycoproteins
  • Mucins
  • Receptors, G-Protein-Coupled