Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass

Kirstine N Bojsen-Møller; Carsten Dirksen; Nils Bruun Jørgensen; Siv Hesse Jacobsen; Annette Karen Lundbeck Serup; Peter Hjorth Albers; Dorte L Hansen; Dorte Worm; Lars Naver; Viggo B Kristiansen; Jørgen Wojtaszewski; Bente Kiens; Jens J Holst; Erik Richter; Sten Madsbad

doi:10.2337/db13-1307

Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass

Kirstine N Bojsen-Møller, Carsten Dirksen, Nils Bruun Jørgensen, Siv Hesse Jacobsen, Annette Karen Lundbeck Serup, Peter Hjorth Albers, Dorte L Hansen, Dorte Worm, Lars Naver, Viggo B Kristiansen, Jørgen Wojtaszewski, Bente Kiens, Jens J Holst, Erik Richter, Sten Madsbad

159 Citations (Scopus)

Abstract

Roux-en-Y gastric bypass (RYGB) improves glycemic control within days after surgery, and changes in insulin sensitivity and β-cell function are likely to be involved. We studied 10 obese patients with type 2 diabetes (T2D) and 10 obese glucose-tolerant subjects before and 1 week, 3 months, and 1 year after RYGB. Participants were included after a preoperative diet-induced total weight loss of -9.2 ± 1.2%. Hepatic and peripheral insulin sensitivity were assessed using the hyperinsulinemic-euglycemic clamp combined with the glucose tracer technique, and β-cell function was evaluated in response to an intravenous glucose-glucagon challenge as well as an oral glucose load. Within 1 week, RYGB reduced basal glucose production, improved basal hepatic insulin sensitivity, and increased insulin clearance, highlighting the liver as an important organ responsible for early effects on glucose metabolism after surgery. Insulin-mediated glucose disposal and suppression of fatty acids did not improve immediately after surgery but increased at 3 months and 1 year; this increase likely was related to the reduction in body weight. Insulin secretion increased after RYGB only in patients with T2D and only in response to oral glucose, underscoring the importance of the changed gut anatomy.

Original language	English
Journal	Diabetes
Volume	63
Issue number	5
Pages (from-to)	1725-1737
Number of pages	13
ISSN	0012-1797
DOIs	https://doi.org/10.2337/db13-1307
Publication status	Published - May 2014

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Bojsen-Møller, K. N., Dirksen, C., Jørgensen, N. B., Jacobsen, S. H., Serup, A. K. L., Albers, P. H., Hansen, D. L., Worm, D., Naver, L., Kristiansen, V. B., Wojtaszewski, J., Kiens, B., Holst, J. J., Richter, E., & Madsbad, S. (2014). Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass. Diabetes, 63(5), 1725-1737. https://doi.org/10.2337/db13-1307

Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass. / Bojsen-Møller, Kirstine N; Dirksen, Carsten; Jørgensen, Nils Bruun et al.
In: Diabetes, Vol. 63, No. 5, 05.2014, p. 1725-1737.

Research output: Contribution to journal › Journal article › Research › peer-review

Bojsen-Møller, KN, Dirksen, C, Jørgensen, NB, Jacobsen, SH, Serup, AKL, Albers, PH, Hansen, DL, Worm, D, Naver, L, Kristiansen, VB, Wojtaszewski, J , Kiens, B , Holst, JJ , Richter, E & Madsbad, S 2014, 'Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass', Diabetes, vol. 63, no. 5, pp. 1725-1737. https://doi.org/10.2337/db13-1307

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abstract = "Roux-en-Y gastric bypass (RYGB) improves glycemic control within days after surgery, and changes in insulin sensitivity and β-cell function are likely to be involved. We studied 10 obese patients with type 2 diabetes (T2D) and 10 obese glucose-tolerant subjects before and 1 week, 3 months, and 1 year after RYGB. Participants were included after a preoperative diet-induced total weight loss of -9.2 ± 1.2%. Hepatic and peripheral insulin sensitivity were assessed using the hyperinsulinemic-euglycemic clamp combined with the glucose tracer technique, and β-cell function was evaluated in response to an intravenous glucose-glucagon challenge as well as an oral glucose load. Within 1 week, RYGB reduced basal glucose production, improved basal hepatic insulin sensitivity, and increased insulin clearance, highlighting the liver as an important organ responsible for early effects on glucose metabolism after surgery. Insulin-mediated glucose disposal and suppression of fatty acids did not improve immediately after surgery but increased at 3 months and 1 year; this increase likely was related to the reduction in body weight. Insulin secretion increased after RYGB only in patients with T2D and only in response to oral glucose, underscoring the importance of the changed gut anatomy.",

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AU - Bojsen-Møller, Kirstine N

AU - Dirksen, Carsten

AU - Jørgensen, Nils Bruun

AU - Jacobsen, Siv Hesse

AU - Serup, Annette Karen Lundbeck

AU - Albers, Peter Hjorth

AU - Hansen, Dorte L

AU - Worm, Dorte

AU - Naver, Lars

AU - Kristiansen, Viggo B

AU - Wojtaszewski, Jørgen

AU - Kiens, Bente

AU - Holst, Jens J

AU - Richter, Erik

AU - Madsbad, Sten

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N2 - Roux-en-Y gastric bypass (RYGB) improves glycemic control within days after surgery, and changes in insulin sensitivity and β-cell function are likely to be involved. We studied 10 obese patients with type 2 diabetes (T2D) and 10 obese glucose-tolerant subjects before and 1 week, 3 months, and 1 year after RYGB. Participants were included after a preoperative diet-induced total weight loss of -9.2 ± 1.2%. Hepatic and peripheral insulin sensitivity were assessed using the hyperinsulinemic-euglycemic clamp combined with the glucose tracer technique, and β-cell function was evaluated in response to an intravenous glucose-glucagon challenge as well as an oral glucose load. Within 1 week, RYGB reduced basal glucose production, improved basal hepatic insulin sensitivity, and increased insulin clearance, highlighting the liver as an important organ responsible for early effects on glucose metabolism after surgery. Insulin-mediated glucose disposal and suppression of fatty acids did not improve immediately after surgery but increased at 3 months and 1 year; this increase likely was related to the reduction in body weight. Insulin secretion increased after RYGB only in patients with T2D and only in response to oral glucose, underscoring the importance of the changed gut anatomy.

AB - Roux-en-Y gastric bypass (RYGB) improves glycemic control within days after surgery, and changes in insulin sensitivity and β-cell function are likely to be involved. We studied 10 obese patients with type 2 diabetes (T2D) and 10 obese glucose-tolerant subjects before and 1 week, 3 months, and 1 year after RYGB. Participants were included after a preoperative diet-induced total weight loss of -9.2 ± 1.2%. Hepatic and peripheral insulin sensitivity were assessed using the hyperinsulinemic-euglycemic clamp combined with the glucose tracer technique, and β-cell function was evaluated in response to an intravenous glucose-glucagon challenge as well as an oral glucose load. Within 1 week, RYGB reduced basal glucose production, improved basal hepatic insulin sensitivity, and increased insulin clearance, highlighting the liver as an important organ responsible for early effects on glucose metabolism after surgery. Insulin-mediated glucose disposal and suppression of fatty acids did not improve immediately after surgery but increased at 3 months and 1 year; this increase likely was related to the reduction in body weight. Insulin secretion increased after RYGB only in patients with T2D and only in response to oral glucose, underscoring the importance of the changed gut anatomy.

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Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass

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