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J Clin Endocrinol Metab. 2013 Jun;98(6):E1066-71. doi: 10.1210/jc.2013-1286. Epub 2013 Apr 22.

Increased hepatic insulin clearance after Roux-en-Y gastric bypass.

Author information

1
Department of Endocrinology 541, Hvidovre Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark. kirstine.bojsen-moeller@regionh.dk

Abstract

CONTEXT:

Roux-en-Y gastric bypass (RYGB) improves glucose tolerance and ameliorates fasting hyperinsulinemia within days after surgery. Improvements in hepatic insulin sensitivity and insulin clearance could contribute importantly to these effects.

OBJECTIVE:

The objective of the investigation was to study changes in insulin clearance after RYGB.

DESIGN:

This was a prospective study of fasting hepatic insulin clearance and, in a subgroup of patients, postprandial insulin clearance after a meal test before and 1 week, 3 months, and 1 year after RYGB.

SETTING:

The study was conducted at Hvidovre Hospital (Hvidovre, Denmark).

PATIENTS:

Patients included 2 groups of obese RYGB-patients: 1) type 2 diabetes (T2D) group: 32 patients with T2D (meal test, n = 13), 2) normal glucose tolerance (NGT) group: 32 patients with NGT (meal test, n = 12).

INTERVENTION:

The intervention was RYGB.

MAIN OUTCOME MEASURE:

Fasting hepatic insulin clearance (fasting C-peptide/fasting insulin). Postprandial insulin clearance (incremental areas under the curve of insulin secretion rates/incremental areas under the curve of insulin).

RESULTS:

Fasting hepatic insulin clearance increased after 1 week (P < .01) and further at 3 months (P < .01), remaining elevated 1 year postoperatively (P < .01) with no difference between the T2D and NGT groups. Postprandial insulin clearance changed only in the T2D group with an increase at 1 week (P < .01) that was maintained at 3 months (P = .06) and 1 year (P < .01).

CONCLUSIONS:

RYGB increases insulin clearance within 1 week after surgery, highlighting the liver as a key organ involved in the early beneficial effect on glucose metabolism. Postprandial insulin secretion may be underestimated postoperatively in patients with type 2 diabetes when evaluated by peripheral insulin concentrations instead of insulin secretion rates or C-peptide.

PMID:
23609835
DOI:
10.1210/jc.2013-1286
[Indexed for MEDLINE]
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