Effects of different metabolic states and surgical models on glucose metabolism and secretion of ileal L-cell peptides: results from the HIPER-1 study

E. Cagiltay, A. Celik, J. B. Dixon, S. Pouwels, S. Santoro, A. Gupta, S. Ugale, M. Abdul-Ghani

Research output: Contribution to journalArticle

Abstract

Aim: To compare the impact of four surgical procedures (mini-gastric bypass, sleeve gastrectomy, ileal transposition and transit bipartition) vs medical management on gut peptide secretion, β-cell function and resolution of hyperglycaemia in people with type 2 diabetes. Research design and methods: A mixed-meal tolerance test was administered 6–24 months after each surgical procedure (mini-gastric bypass, sleeve gastrectomy, ileal transposition and transit bipartition; n=30 in each group) and the results were compared with those obtained in matched lean (n=30) and obese (n=30) people with type 2 diabetes undergoing medical management. Results: Participants in the mini-gastric bypass and ileal transposition groups had a greater increase in plasma glucose concentration after the mixed-meal tolerance test than those in the sleeve gastrectomy and transit bipartition groups. Participants in the mini-gastric bypass group exhibited the greatest increase in the incremental area under the curve of plasma glucose concentration above baseline (P<0.0001). Insulin sensitivity was similar across surgical groups, and statistically greater in participants in the surgical groups than in obese participants in the non-surgical group (P<0.0001). β-cell responsiveness to glucose was greater in participants in the sleeve gastrectomy and transit bipartition groups than in the mini-gastric bypass and ileal transposition groups (P<0.001) despite a smaller incremental increase above baseline in the area under the plasma glucagon-like peptide-1 concentration curve relative to ileal transposition. Postoperative β-cell function was the strongest predictor of hyperglycaemia resolution. Conclusions: The present study showed that the level of β-cell function after bariatric surgery is the strongest predictor of hyperglycaemia resolution. The study also demonstrates a disconnect between postprandial GLP-1 levels and β-cell function among the studied surgical procedures.

Original languageEnglish (US)
Pages (from-to)697-704
Number of pages8
JournalDiabetic Medicine
Volume37
Issue number4
DOIs
StatePublished - Apr 1 2020

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ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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