Time Course of Metabolic, Neuroendocrine, and Adipose Effects During 2 Years of Follow-up After Gastric Bypass in Patients With Type 2 Diabetes.
J Clin Endocrinol Metab
; 106(10): e4049-e4061, 2021 09 27.
Article
em En
| MEDLINE
| ID: mdl-34086911
ABSTRACT
CONTEXT Roux-en-Y gastric bypass surgery (RYGB) markedly improves glycemia in patients with type 2 diabetes (T2D), but underlying mechanisms and changes over time are incompletely understood. OBJECTIVE:
Integrated assessment of neuroendocrine and metabolic changes over time in T2D patients undergoing RYGB. DESIGN ANDSETTING:
Follow-up of single-center randomized study. PATIENTS Thirteen patients with obesity and T2D compared to 22 healthy subjects.INTERVENTIONS:
Blood chemistry, adipose biopsies, and heart rate variability were obtained before and 4, 24, and 104 weeks post-RYGB.RESULTS:
After RYGB, glucose-lowering drugs were discontinued and hemoglobin A1c fell from mean 55 to 41 mmol/mol by 104 weeks (Pâ <â 0.001). At 4 weeks, morning cortisol (Pâ <â 0.05) and adrenocorticotropin (Pâ =â 0.09) were reduced by 20%. Parasympathetic nerve activity (heart rate variability derived) increased at 4 weeks (Pâ <â 0.05) and peaked at 24 weeks (Pâ <â 0.01). C-reactive protein (CRP) and white blood cells were rapidly reduced (Pâ <â 0.01). At 104 weeks, basal and insulin-stimulated adipocyte glucose uptake increased by 3-fold vs baseline and expression of genes involved in glucose transport, fatty acid oxidation, and adipogenesis was upregulated (Pâ <â 0.01). Adipocyte volume was reduced by 4 weeks and more markedly at 104 weeks, by about 40% vs baseline (Pâ <â 0.01).CONCLUSIONS:
We propose this order of events (1) rapid glucose lowering (days); (2) attenuated cortisol axis activity and inflammation and increased parasympathetic tone (weeks); and (3) body fat and weight loss, increased adipose glucose uptake, and whole-body insulin sensitivity (months-years; similar to healthy controls). Thus, neuroendocrine pathways can partly mediate early glycemic improvement after RYGB, and adipose factors may promote long-term insulin sensitivity and normoglycemia.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Derivação Gástrica
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Tecido Adiposo
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Diabetes Mellitus Tipo 2
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Sistemas Neurossecretores
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article