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Author Notes:

Address correspondence and reprint requests to Edward Lin, D.O., Department of Surgery, Emory University School of Medicine, 1364 Clifton Road (H124), Atlanta, GA 30322. Elin2@emory.edu

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Research Funding:

This study is funded in part by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases R03 DK067167 (NGM) and National Institutes of Health/ACTSI Grant M01 RR00039.

Dual Mechanism for Type-2 Diabetes Resolution after Roux-en-Y Gastric Bypass

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Journal Title:

American Surgeon

Volume:

Volume 75, Number 6

Publisher:

, Pages 498-503

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Resolution of Type-2 diabetes mellitus (DM) after weight loss surgery is well documented, but the mechanism is elusive. We evaluated the glucose-insulin metabolism of patients undergoing a Roux-en-Y gastric bypass (RYGB) using the intravenous glucose tolerance test (IVGTT) and compared it with patients who underwent laparoscopic adjustable gastric band (AB) placement. Thirty-one female patients (age range, 20 to 50 years; body mass index, 47.2 kg/m2) underwent RYGB. Nine female patients underwent AB placement and served as control subjects. All patients underwent IVGTT at baseline and 1 month and 6 months after surgery. Thirteen patients undergoing RYGB and one patient undergoing AB exhibited impaired glucose tolerance defined by the American Diabetes Association. By 6 months post surgery, diabetes was resolved in all but one patient undergoing RYGB and none of the patients undergoing AB. Patients with diabetes undergoing demonstrated increased insulin secretion and β-cell responsiveness 1 month after surgery and continued this trend up to 6 months, whereas none of the patients undergoing AB had changes in β-cell function. Both patients undergoing RYGB and those undergoing AB demonstrated significant weight loss (34.6 and 35.0 kg/m2, respectively) and improved insulin sensitivity at 6 months. RYGB ameliorates DM resolution in two phases: 1) early augmentation of beta cell function at 1 month; and 2) attenuation of peripheral insulin resistance at 6 months. Patients undergoing AB only exhibited reduction in peripheral insulin resistance at 6 months but no changes in insulin secretion.
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