Increased Hepatic Insulin Clearance After Roux-en-Y Gastric Bypass

TY - JOUR

T1 - Increased Hepatic Insulin Clearance After Roux-en-Y Gastric Bypass

AU - Bojsen-Møller, Kirstine N

AU - Dirksen, Carsten

AU - Jørgensen, Nils B

AU - Jacobsen, Siv H

AU - Hansen, Dorte L

AU - Worm, Dorte

AU - Naver, Lars

AU - Kristiansen, Viggo B

AU - Holst, Jens Juul

AU - Madsbad, Sten

PY - 2013/6

Y1 - 2013/6

N2 - Context: Roux-en-Y gastric bypass (RYGB) improves glucose tolerance and ameliorates fasting hyperinsulinemia within days after surgery. Improvements in hepatic insulin sensitivity and insulin clearance could contribute importantly to these effects. Objective: The objective of the investigation was to study changes in insulin clearance after RYGB. Design: This was a prospective study of fasting hepatic insulin clearance and, in a subgroup of patients, postprandial insulin clearance after a meal test before and 1 week, 3 months, and 1 year after RYGB. Setting: The study was conducted at Hvidovre Hospital (Hvidovre, Denmark). Patients: Patients included 2 groups of obese RYGB-patients: 1) type 2 diabetes (T2D) group: 32 patients with T2D (meal test, n = 13), 2) normal glucose tolerance (NGT) group: 32 patients with NGT (meal test, n = 12). Intervention: The intervention was RYGB. Main Outcome Measure: Fasting hepatic insulin clearance (fasting C-peptide/fasting insulin). Postprandial insulin clearance (incremental areas under the curve of insulin secretion rates/incremental areas under the curve of insulin). Results: Fasting hepatic insulin clearance increased after 1 week (P < .01) and further at 3 months (P < .01), remaining elevated 1 year postoperatively (P < .01) with no difference between the T2D and NGT groups. Postprandial insulin clearance changed only in the T2D group with an increase at 1 week (P < .01) that was maintained at 3 months (P = .06) and 1 year (P < .01). Conclusions: RYGB increases insulin clearance within 1 week after surgery, highlighting the liver as a key organ involved in the early beneficial effect on glucose metabolism. Postprandial insulin secretion may be underestimated postoperatively in patients with type 2 diabetes when evaluated by peripheral insulin concentrations instead of insulin secretion rates or C-peptide.

AB - Context: Roux-en-Y gastric bypass (RYGB) improves glucose tolerance and ameliorates fasting hyperinsulinemia within days after surgery. Improvements in hepatic insulin sensitivity and insulin clearance could contribute importantly to these effects. Objective: The objective of the investigation was to study changes in insulin clearance after RYGB. Design: This was a prospective study of fasting hepatic insulin clearance and, in a subgroup of patients, postprandial insulin clearance after a meal test before and 1 week, 3 months, and 1 year after RYGB. Setting: The study was conducted at Hvidovre Hospital (Hvidovre, Denmark). Patients: Patients included 2 groups of obese RYGB-patients: 1) type 2 diabetes (T2D) group: 32 patients with T2D (meal test, n = 13), 2) normal glucose tolerance (NGT) group: 32 patients with NGT (meal test, n = 12). Intervention: The intervention was RYGB. Main Outcome Measure: Fasting hepatic insulin clearance (fasting C-peptide/fasting insulin). Postprandial insulin clearance (incremental areas under the curve of insulin secretion rates/incremental areas under the curve of insulin). Results: Fasting hepatic insulin clearance increased after 1 week (P < .01) and further at 3 months (P < .01), remaining elevated 1 year postoperatively (P < .01) with no difference between the T2D and NGT groups. Postprandial insulin clearance changed only in the T2D group with an increase at 1 week (P < .01) that was maintained at 3 months (P = .06) and 1 year (P < .01). Conclusions: RYGB increases insulin clearance within 1 week after surgery, highlighting the liver as a key organ involved in the early beneficial effect on glucose metabolism. Postprandial insulin secretion may be underestimated postoperatively in patients with type 2 diabetes when evaluated by peripheral insulin concentrations instead of insulin secretion rates or C-peptide.

U2 - 10.1210/jc.2013-1286

DO - 10.1210/jc.2013-1286

M3 - Journal article

C2 - 23609835

SN - 0021-972X

VL - 98

SP - E1066-E1071

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

IS - 6

ER -