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Gastric Emptying of Orally Administered Glucose Solutions and Incretin Hormone Responses Are Unaffected by Laparoscopic Adjustable Gastric Banding

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Abstract

Background

Laparoscopic adjustable gastric banding (LAGB) provides weight loss in obese individuals and is associated with improved glucose homeostasis and resolution of type 2 diabetes. However, in most available reports, potentially inappropriate methodology has been applied when measuring the impact of LAGB on glucose intolerance. In order to clarify the applicability of the diagnostic 75 g-oral glucose tolerance test (OGTT) to measure the effect of LAGB on glucose metabolism, we investigated the effect of LAGB on gastric emptying for liquids as well as pancreatic and incretin hormone responses.

Methods

Eight obese patients (three with normal glucose tolerance, three with impaired glucose tolerance, and two with type 2 diabetes; age 47.5 ± 1.1 years (mean±SEM); body mass index 44 ± 1 kg/m2; HbA1c 6.2 ± 0.4%) underwent a 75 g-oral glucose tolerance test with 1 g acetaminophen before and ~6 weeks after LAGB.

Results

A small weight reduction was seen after LAGB (125 ± 8 vs. 121 ± 8 kg, P = 0.014). No differences in determinants of gastric emptying were observed before and after LAGB (area under the serum acetaminophen curve 10.1 ± 0.6 vs. 9.8 ± 0.5 mM×4 h, P = 0.8; peak acetaminophen concentration 62 ± 3 vs. 61 ± 3 μM, P = 0.8; acetaminophen peak time 98 ± 6 vs. 100 ± 6 min, P = 0.9). No differences in plasma glucose, insulin, C-peptide, glucagon, glucose-dependent insulinotropic polypeptide, or glucagon-like peptide-1 responses to the OGTT were observed before as compared to after LAGB.

Conclusions

OGTT can be used to evaluate glucose tolerance in obese patients before and after LAGB without bias from changes in gastric emptying. LAGB has no direct impact on incretin hormone secretion.

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Abbreviations

AUC:

Area under curve

BMI:

Body mass index

FPG:

Fasting plasma glucose

GIP:

Glucose-dependent insulinotropic polypeptide

GLP-1:

Glucagon-like peptide-1

HbA1c:

Glycated hemoglobin A1c

HOMA:

The homeostatic model assessment

HOMAIR :

Insulin resistance according to HOMA

IGT:

Impaired glucose tolerance

LAGB:

Laparoscopic adjustable gastric banding

OGTT:

Oral glucose tolerance test

SEM:

Standard error of the mean

WHO:

World Health Organization

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Acknowledgments

We thank all participants for spending time on this project and we are grateful for the technical assistance of Helle Lethmer, Lisbeth Andreasen, Marlene Rohr, Sofie Pilgaard, and Lene Albæk. This work was made possible by an EFSD/Novartis research grant.

Conflict of Interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Internal Medicine M, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark

    Lotte Usinger & Steen Larsen

  2. Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark

    Katrine B. Hansen

  3. Department of Gastroenterology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark

    Viggo B. Kristiansen

  4. Diabetes Research Division, Department of Internal Medicine F, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Copenhagen, Denmark

    Filip K. Knop

  5. Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Copenhagen, Denmark

    Jens J. Holst

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  1. Lotte Usinger
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Correspondence to Filip K. Knop.

Additional information

Lotte Usinger and Katrine B. Hansen contributed equally to the present work.

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Usinger, L., Hansen, K.B., Kristiansen, V.B. et al. Gastric Emptying of Orally Administered Glucose Solutions and Incretin Hormone Responses Are Unaffected by Laparoscopic Adjustable Gastric Banding. OBES SURG 21, 625–632 (2011). https://doi.org/10.1007/s11695-011-0362-9

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