fbpx

Science

Study Title
Rapid Improvement in Diabetes After Gastric Bypass Surgery
Publication
Diabetes Care
Author(s)

ILDIKO LINGVAY, MD, MPH, MSCS, ARSALLA ISLAM, MD, EVE GUTH, MD, EDWARD LIVINGSTON, MD

Abstract

OBJECTIVE: Improvements in diabetes after Roux-en-Y gastric bypass (RYGB) often occur days after surgery. Surgically induced hormonal changes and the restrictive postoperative diet are proposed mechanisms. We evaluated the contribution of caloric restriction versus surgically induced changes to glucose homeostasis in the immediate postoperative period.
RESEARCH DESIGN AND METHODS: Patients with type 2 diabetes planning to undergo RYGB participated in a prospective two-period study (each period involved a 10-day inpatient stay, and periods were separated by a minimum of 6 weeks of wash-out) in which patients served as their own controls. The presurgery period consisted of diet alone. The post- surgery period was matched in all aspects (daily matched diet) and included RYGB surgery. Glucose measurements were performed every 4 h throughout the study. A mixed-meal challenge test was performed before and after each period.
RESULTS: Ten patients completed the study and had the following characteristics: age, 53.2 years (95% CI, 48.0–58.4); BMI, 51.2 kg/m2 (46.1–56.4); diabetes duration, 7.4 years (4.8– 10.0); and HbA1c, 8.52% (7.08–9.96). Patients lost 7.3 kg (8.1–6.5) during the presurgery period versus 4.0 kg (6.2–1.7) during the post-surgery period (P = 0.01 between periods). Daily glycemia in the presurgery period was significantly lower (1,293.58 mg/dLzday [1,096.83– 1,490.33) vs. 1,478.80 mg/dLzday [1,277.47–1,680.13]) compared with the postsurgery period (P = 0.02 between periods). The improvements in the fasting and maximum poststimulation glucose and 6-h glucose area under the curve (primary outcome) were similar during both periods.
CONCLUSIONS: Glucose homeostasis improved in response to a reduced caloric diet, with a greater effect observed in the absence of surgery as compared with after RYGB. These findings suggest that reduced calorie ingestion can explain the marked improvement in diabetes control observed after RYGB.

Date
September 12, 2013
View study

Share This

Related Topics

FastingDiabetes

Dr. Perlmutter is one of the leading lights in medicine today, illuminating the path for solving chronic illness

Mark Hyman, MD