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GLP-1 Response to a Mixed Meal: What Happens 10 Years after Roux-en-Y Gastric Bypass (RYGB)?

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Abstract

Background

Oral meal consumption increases glucagon-like peptide 1 (GLP-1) release which maintains euglycemia by increasing insulin secretion. This effect is exaggerated during short-term follow-up of Roux-en-y gastric bypass (RYGB). We examined the durability of this effect in patient with type 2 diabetes (T2DM) >10 years after RYGB.

Methods

GLP-1 response to a mixed meal in the 10-year post-RYGB group (n = 5) was compared to lean (n = 9), obese (n = 6), and type 2 diabetic (n = 10) controls using a cross-sectional study design. Analysis of variance (ANOVA) was used to evaluate GLP-1 response to mixed meal consumption from 0 to 300 min, 0–20 min, 20–60 min, and 60–300 min, respectively. Weight, insulin resistance, and T2DM were also assessed.

Results

GLP-1 response 0–300 min in the 10-year post-RYGB showed a statistically significant overall difference (p = 0.01) compared to controls. Furthermore, GLP-1 response 0–20 min in the 10-year post-RYGB group showed a very rapid statistically significant rise (p = 0.035) to a peak of 40 pM. GLP-1 response between 20 and 60 min showed a rapid statistically significant (p = 0.041) decline in GLP-1 response from ~40 pM to 10 pM. GLP-1 response in the 10-year post-RYGB group from 60 to 300 min showed no statistically significant difference from controls. BMI, HOMA, and fasting serum glucose before and >10 years after RYGB changed from 59.9 → 40.4, 8.7 → 0.88, and 155.2 → 87.6 mg/dl, respectively, and were statistically significant (p < 0.05).

Conclusions

An exaggerated GLP-1 response was noted 10 years after RYGB, strongly suggesting a durability of this effect. This phenomenon may play a key role in maintaining type 2 diabetes remission and weight loss after RYGB.

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Acknowledgments

We acknowledge Melissa Anne Reed, Brody School of Medicine, Department of Physiology PhD candidate, Greenville, NC for her assistance with data collection and editorial feedback on the manuscript and Kenneth MacDonald, MD, Physician’s East, Inc., Greenville, NC for assistance with recruitment of patients. This work was supported by a Research Development Award granted by the Division of Research & Graduate Studies at East Carolina University.

Disclosures

The authors have no relevant conflict of interest to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine, Section of Endocrinology & Metabolism, Brody School of Medicine at East Carolina University, 3E-129 Brody Building, 600 Moye Boulevard, Greenville, NC, 27834, USA

    Moahad S. Dar, Almond J. Drake III & Robert J. Tanenberg

  2. Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, 27834, USA

    William H. Chapman III, John R. Pender & Walter J. Pories

  3. Department of Biostatistics, East Carolina University, Greenville, NC, 27834, USA

    Kevin O’Brien

  4. Department of Physiology, Brody School of Medicine at East Carolina University, Greenville, NC, 27834, USA

    G. Lynis Dohm

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  1. Moahad S. Dar
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Correspondence to Moahad S. Dar.

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Dar, M.S., Chapman, W.H., Pender, J.R. et al. GLP-1 Response to a Mixed Meal: What Happens 10 Years after Roux-en-Y Gastric Bypass (RYGB)?. OBES SURG 22, 1077–1083 (2012). https://doi.org/10.1007/s11695-012-0624-1

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