Effects of Diet versus Gastric Bypass on Metabolic Function in Diabetes

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Mihoko Yoshino 1, Brandon D Kayser 1, Jun Yoshino 1, Richard I Stein 1, Dominic Reeds 1, J Christopher Eagon 1, Shaina R Eckhouse 1, Jeramie D Watrous 1, Mohit Jain 1, Rob Knight 1, Kenneth Schechtman 1, Bruce W Patterson 1, Samuel Klein 1

Main idea: In this study involving patients with obesity and type 2 diabetes, the metabolic benefits of gastric bypass surgery and diet were similar and were apparently related to weight loss itself, with no evident clinically important effects independent of weight loss.

Abstract

Background: Some studies have suggested that in people with type 2 diabetes, Roux-en-Y gastric bypass has therapeutic effects on metabolic function that are independent of weight loss.

Methods: We evaluated metabolic regulators of glucose homeostasis before and after matched (approximately 18%) weight loss induced by gastric bypass (surgery group) or diet alone (diet group) in 22 patients with obesity and diabetes. The primary outcome was the change in hepatic insulin sensitivity, assessed by infusion of insulin at low rates (stages 1 and 2 of a 3-stage hyperinsulinemic euglycemic pancreatic clamp). Secondary outcomes were changes in muscle insulin sensitivity, beta-cell function, and 24-hour plasma glucose and insulin profiles. Results: Weight loss was associated with increases in mean suppression of glucose production from baseline. Weight loss increased beta-cell function (insulin secretion relative to insulin sensitivity) in the diet group and in the surgery group. It decreased the areas under the curve for 24-hour plasma glucose and insulin levels in both groups, with no significant difference between the groups. No major complications occurred in either group.  The Daily Discussion is a weekly, offbeat look at stories you may have missed.

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