Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes: Effects of bariatric surgery vs standard medical therapy

S. K. Malin; A. Samat; K. Wolski; B. Abood; C. E. Pothier; D. L. Bhatt; S. Nissen; S. A. Brethauer; P. R. Schauer; J. P. Kirwan; S. R. Kashyap

doi:10.1038/ijo.2013.196

Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes: Effects of bariatric surgery vs standard medical therapy

S. K. Malin, A. Samat, K. Wolski, B. Abood, C. E. Pothier, D. L. Bhatt, S. Nissen, S. A. Brethauer, P. R. Schauer, J. P. Kirwan, S. R. Kashyap

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Abstract

Objective:Roux-en-Y gastric bypass (RYGB) produces more durable glycemic control than sleeve gastrectomy (SG) or intensive medical therapy (IMT). However, the contribution of acylated ghrelin (AG), a gluco-regulatory/appetite hormone, to improve glucose metabolism and body composition in patients with type 2 diabetes (T2D) following RYGB is unknown.Design:STAMPEDE (Surgical Treatment and Medication Potentially Eradicate Diabetes Efficiently) was a prospective, randomized controlled trial.Subjects:Fifty-three (body mass index: 36±3 kg m -2, age: 49±9 years) poorly controlled patients with T2D (HbA 1c (glycated hemoglobin): 9.7±2%) were randomized to IMT, IMT+RYGB or IMT+SG and underwent a mixed-meal tolerance test at baseline, 12, and 24 months for evaluation of AG suppression (postprandial minus fasting) and beta-cell function (oral disposition index; glucose-stimulated insulin secretion × Matsuda index). Total/android body fat (dual-energy X-ray absorptiometry) was also assessed.Results:RYGB and SG reduced body fat comparably (15-23 kg) at 12 and 24 months, whereas IMT had no effect. Beta-cell function increased 5.8-fold in RYGB and was greater than IMT at 24 months (P<0.001). However, there was no difference in insulin secretion between SG vs IMT at 24 months (P=0.32). Fasting AG was reduced fourfold following SG (P<0.01) and did not change with RYGB or IMT at 24 months. AG suppression improved more following RYGB than SG or IMT at 24 months (P=0.01 vs SG, P=0.07 vs IMT). At 24 months, AG suppression was associated with increased postprandial glucagon-like peptide-1 (r=-0.32, P<0.02) and decreased android fat (r=0.38; P<0.006).Conclusions:Enhanced AG suppression persists for up to 2 years after RYGB, and this effect is associated with decreased android obesity and improved insulin secretion. Together, these findings suggest that AG suppression is partly responsible for the improved glucose control after RYGB surgery.

Original language	English
Pages (from-to)	364-370
Number of pages	7
Journal	International Journal of Obesity
Volume	38
Issue number	3
DOIs	https://doi.org/10.1038/ijo.2013.196
State	Published - Mar 2014
Externally published	Yes

Keywords

bariatric surgery
diabetes
gastrointestinal hormones
glycemic control
insulin resistance
insulin secretion

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10.1038/ijo.2013.196

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Malin, S. K., Samat, A., Wolski, K., Abood, B., Pothier, C. E., Bhatt, D. L., Nissen, S., Brethauer, S. A., Schauer, P. R., Kirwan, J. P., & Kashyap, S. R. (2014). Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes: Effects of bariatric surgery vs standard medical therapy. International Journal of Obesity, 38(3), 364-370. https://doi.org/10.1038/ijo.2013.196

@article{8c01f48f2f8a4bc2aed2cad974c5163c,

title = "Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes: Effects of bariatric surgery vs standard medical therapy",

abstract = "Objective:Roux-en-Y gastric bypass (RYGB) produces more durable glycemic control than sleeve gastrectomy (SG) or intensive medical therapy (IMT). However, the contribution of acylated ghrelin (AG), a gluco-regulatory/appetite hormone, to improve glucose metabolism and body composition in patients with type 2 diabetes (T2D) following RYGB is unknown.Design:STAMPEDE (Surgical Treatment and Medication Potentially Eradicate Diabetes Efficiently) was a prospective, randomized controlled trial.Subjects:Fifty-three (body mass index: 36±3 kg m -2, age: 49±9 years) poorly controlled patients with T2D (HbA 1c (glycated hemoglobin): 9.7±2%) were randomized to IMT, IMT+RYGB or IMT+SG and underwent a mixed-meal tolerance test at baseline, 12, and 24 months for evaluation of AG suppression (postprandial minus fasting) and beta-cell function (oral disposition index; glucose-stimulated insulin secretion × Matsuda index). Total/android body fat (dual-energy X-ray absorptiometry) was also assessed.Results:RYGB and SG reduced body fat comparably (15-23 kg) at 12 and 24 months, whereas IMT had no effect. Beta-cell function increased 5.8-fold in RYGB and was greater than IMT at 24 months (P<0.001). However, there was no difference in insulin secretion between SG vs IMT at 24 months (P=0.32). Fasting AG was reduced fourfold following SG (P<0.01) and did not change with RYGB or IMT at 24 months. AG suppression improved more following RYGB than SG or IMT at 24 months (P=0.01 vs SG, P=0.07 vs IMT). At 24 months, AG suppression was associated with increased postprandial glucagon-like peptide-1 (r=-0.32, P<0.02) and decreased android fat (r=0.38; P<0.006).Conclusions:Enhanced AG suppression persists for up to 2 years after RYGB, and this effect is associated with decreased android obesity and improved insulin secretion. Together, these findings suggest that AG suppression is partly responsible for the improved glucose control after RYGB surgery.",

keywords = "bariatric surgery, diabetes, gastrointestinal hormones, glycemic control, insulin resistance, insulin secretion",

author = "Malin, {S. K.} and A. Samat and K. Wolski and B. Abood and Pothier, {C. E.} and Bhatt, {D. L.} and S. Nissen and Brethauer, {S. A.} and Schauer, {P. R.} and Kirwan, {J. P.} and Kashyap, {S. R.}",

year = "2014",

month = mar,

doi = "10.1038/ijo.2013.196",

language = "English",

volume = "38",

pages = "364--370",

journal = "International Journal of Obesity",

issn = "0307-0565",

publisher = "Springer Nature",

number = "3",

}

Malin, SK, Samat, A, Wolski, K, Abood, B, Pothier, CE, Bhatt, DL, Nissen, S, Brethauer, SA, Schauer, PR, Kirwan, JP & Kashyap, SR 2014, 'Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes: Effects of bariatric surgery vs standard medical therapy', International Journal of Obesity, vol. 38, no. 3, pp. 364-370. https://doi.org/10.1038/ijo.2013.196

TY - JOUR

T1 - Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes

T2 - Effects of bariatric surgery vs standard medical therapy

AU - Malin, S. K.

AU - Samat, A.

AU - Wolski, K.

AU - Abood, B.

AU - Pothier, C. E.

AU - Bhatt, D. L.

AU - Nissen, S.

AU - Brethauer, S. A.

AU - Schauer, P. R.

AU - Kirwan, J. P.

AU - Kashyap, S. R.

PY - 2014/3

Y1 - 2014/3

N2 - Objective:Roux-en-Y gastric bypass (RYGB) produces more durable glycemic control than sleeve gastrectomy (SG) or intensive medical therapy (IMT). However, the contribution of acylated ghrelin (AG), a gluco-regulatory/appetite hormone, to improve glucose metabolism and body composition in patients with type 2 diabetes (T2D) following RYGB is unknown.Design:STAMPEDE (Surgical Treatment and Medication Potentially Eradicate Diabetes Efficiently) was a prospective, randomized controlled trial.Subjects:Fifty-three (body mass index: 36±3 kg m -2, age: 49±9 years) poorly controlled patients with T2D (HbA 1c (glycated hemoglobin): 9.7±2%) were randomized to IMT, IMT+RYGB or IMT+SG and underwent a mixed-meal tolerance test at baseline, 12, and 24 months for evaluation of AG suppression (postprandial minus fasting) and beta-cell function (oral disposition index; glucose-stimulated insulin secretion × Matsuda index). Total/android body fat (dual-energy X-ray absorptiometry) was also assessed.Results:RYGB and SG reduced body fat comparably (15-23 kg) at 12 and 24 months, whereas IMT had no effect. Beta-cell function increased 5.8-fold in RYGB and was greater than IMT at 24 months (P<0.001). However, there was no difference in insulin secretion between SG vs IMT at 24 months (P=0.32). Fasting AG was reduced fourfold following SG (P<0.01) and did not change with RYGB or IMT at 24 months. AG suppression improved more following RYGB than SG or IMT at 24 months (P=0.01 vs SG, P=0.07 vs IMT). At 24 months, AG suppression was associated with increased postprandial glucagon-like peptide-1 (r=-0.32, P<0.02) and decreased android fat (r=0.38; P<0.006).Conclusions:Enhanced AG suppression persists for up to 2 years after RYGB, and this effect is associated with decreased android obesity and improved insulin secretion. Together, these findings suggest that AG suppression is partly responsible for the improved glucose control after RYGB surgery.

AB - Objective:Roux-en-Y gastric bypass (RYGB) produces more durable glycemic control than sleeve gastrectomy (SG) or intensive medical therapy (IMT). However, the contribution of acylated ghrelin (AG), a gluco-regulatory/appetite hormone, to improve glucose metabolism and body composition in patients with type 2 diabetes (T2D) following RYGB is unknown.Design:STAMPEDE (Surgical Treatment and Medication Potentially Eradicate Diabetes Efficiently) was a prospective, randomized controlled trial.Subjects:Fifty-three (body mass index: 36±3 kg m -2, age: 49±9 years) poorly controlled patients with T2D (HbA 1c (glycated hemoglobin): 9.7±2%) were randomized to IMT, IMT+RYGB or IMT+SG and underwent a mixed-meal tolerance test at baseline, 12, and 24 months for evaluation of AG suppression (postprandial minus fasting) and beta-cell function (oral disposition index; glucose-stimulated insulin secretion × Matsuda index). Total/android body fat (dual-energy X-ray absorptiometry) was also assessed.Results:RYGB and SG reduced body fat comparably (15-23 kg) at 12 and 24 months, whereas IMT had no effect. Beta-cell function increased 5.8-fold in RYGB and was greater than IMT at 24 months (P<0.001). However, there was no difference in insulin secretion between SG vs IMT at 24 months (P=0.32). Fasting AG was reduced fourfold following SG (P<0.01) and did not change with RYGB or IMT at 24 months. AG suppression improved more following RYGB than SG or IMT at 24 months (P=0.01 vs SG, P=0.07 vs IMT). At 24 months, AG suppression was associated with increased postprandial glucagon-like peptide-1 (r=-0.32, P<0.02) and decreased android fat (r=0.38; P<0.006).Conclusions:Enhanced AG suppression persists for up to 2 years after RYGB, and this effect is associated with decreased android obesity and improved insulin secretion. Together, these findings suggest that AG suppression is partly responsible for the improved glucose control after RYGB surgery.

KW - bariatric surgery

KW - diabetes

KW - gastrointestinal hormones

KW - glycemic control

KW - insulin resistance

KW - insulin secretion

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U2 - 10.1038/ijo.2013.196

DO - 10.1038/ijo.2013.196

M3 - Article

C2 - 24166065

AN - SCOPUS:84896315912

SN - 0307-0565

VL - 38

SP - 364

EP - 370

JO - International Journal of Obesity

JF - International Journal of Obesity

IS - 3

ER -

Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes: Effects of bariatric surgery vs standard medical therapy

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Keywords

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