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Endocrine. 2020 Jan 26. doi: 10.1007/s12020-020-02203-w. [Epub ahead of print]

Rapid changes in neuroendocrine regulation may contribute to reversal of type 2 diabetes after gastric bypass surgery.

Author information

1
Department of Medical Science, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden.
2
Radiation Sciences, Biomedical Engineering & Informatics, Umeå University, Umeå, Sweden.
3
Surgical Sciences, Uppsala University, Uppsala, Sweden.
4
Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden.
5
Department of Medical Science, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden. jan.eriksson@medsci.uu.se.

Abstract

OBJECTIVE:

To explore the role of hormones and the autonomic nervous system in the rapid remission of diabetes after Roux-en-Y Gastric Bypass (RYGB).

RESEARCH DESIGN AND METHODS:

Nineteen obese patients with type 2 diabetes, 7 M/12 F, were randomized (2:1) to RYGB or standard-of-care medical treatment (control). At baseline and 4 and 24 weeks post surgery, fasting blood sampling, OGTT, intravenous arginine challenge, and heart-rate variability (HRV) assessments were performed.

RESULTS:

At both 4 and 24 weeks post-RYGB the following effects were found: arginine-stimulated insulin secretion was reduced. GLP-1, GIP, and glucagon rise during OGTT was enhanced. IGF-1 and GH levels increased. In addition, total HRV and spectral components PLF (power of low frequency) and PHF (power of high frequency) increased. At 4 weeks, morning cortisol was lower than baseline and 24 weeks. At 24 weeks, NEFA levels during OGTT, and the PLF/PHF ratio decreased. None of these changes were seen in the control group.

CONCLUSIONS:

There were rapid changes within 4 weeks after RYGB: signs of enhanced parasympathetic nerve activity, reduced morning cortisol, and enhanced incretin and glucagon responses to glucose. The findings suggest that neurohormonal mechanisms can contribute to the rapid improvement of insulin resistance and glycemia following RYGB in type 2 diabetes.

KEYWORDS:

Adipokines; Heart rate variability; Incretins; Roux-en-Y gastric bypass; Type 2 diabetes

PMID:
31983031
DOI:
10.1007/s12020-020-02203-w

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