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 caused 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.
The results
Weight loss was associated with increases in mean suppression of baseline glucose production, by 7.04 μmol per kilogram fat-free mass per minute (95% confidence interval [CI], 4.74 to 9.33) in the diet group and by 7.02 μmol per kilogram fat-free mass per minute (95% CI, 3.21 to 10.84) in the surgery group during clamp phase 1, and by 5, 39 (95% CI, 2.44 to 8.34) and 5.37 (95% CI, 2.41 to 8.33) μmol per kilogram of fat-free mass per minute in the two groups, respectively, during clamping step 2; there were no significant differences between the groups. Weight loss was associated with increased insulin-stimulated glucose availability, from 30.5 ± 15.9 to 61.6 ± 13.0 μmol per kilogram of fat-free mass per minute in the diet group and from 29.4 ± 12.6 to 54 , 5 ± 10.4 μmol per kilogram fat-free mass per minute in the surgery group; there was no significant difference between the groups. Weight loss increased beta-cell function (insulin secretion relative to insulin sensitivity) by 1.83 units (95% CI, 1.22 to 2.44) in the diet group and by 1.11 units (95% CI, 0.08 to 2, 15) in the surgery group, with no significant difference between the groups, and 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.
Conclusions
In this study involving patients with obesity and diabetes 2, the metabolic benefits of gastric bypass surgery and diet were similar and were apparently related to weight loss itself, with no evident clinically significant effects independent of weight loss. (Founded by the National Institutes of Health and others; ClinicalTrials.gov, NCT02207777.)
