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.
David Bradley, Caterina Conte, Bettina Mittendorfer, J. Christopher Eagon, J. Esteban Varela, Elisa Fabbrini, Amalia Gastaldelli, Kari T. Chambers, Xiong Su, Adewole Okunade, Bruce W. Patterson, Samuel Klein
Plasma glucose concentration, ingested glucose Ra into the systemic circulation, EGP rate, and EGP as percentage of total glucose Ra into the systemic circulation after ingestion of a mixed meal (consumed over 30 minutes) before and after 20% weight loss induced by LAGB or RYGB surgery.
Weight loss–induced changes in all parameters shown were significantly different between LAGB and RYGB groups (