Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Feb;67(2):344-353.
doi: 10.1007/s12020-020-02203-w. Epub 2020 Jan 26.

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

Petros Katsogiannos  1 , Prasad G Kamble  1 , Urban Wiklund  2 , Magnus Sundbom  3 , Daniel Espes  1   4 , Ulf Hammar  1 , F Anders Karlsson  1 , Maria J Pereira  1 , Jan W Eriksson  5
Affiliations
Randomized Controlled Trial

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

Petros Katsogiannos et al. Endocrine. 2020 Feb.

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.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Plasma incretins and glucagon in response to OGTT in surgery and control groups. a GLP-1 in surgery group; b GLP-1 in control group; c GIP in surgery group; d GIP in control group; e glucagon in surgery group; f glucagon in control group. Data are shown as mean ± 95% CI. a,ABaseline vs post surgery at 4 weeks. b,BBaseline vs post surgery at 24 weeks. c,C4 weeks vs post surgery at 24 weeks. Lower case letters; p < 0.05, upper case letters; p < 0.01
Fig. 2
Fig. 2
Arginine-stimulated insulin secretion in surgery and control groups. a Insulin levels during arginine challenge in surgery group, b insulin levels during arginine challenge in control group. Data are shown as mean ± 95% CI. ABaseline vs post surgery at 4 weeks. Bbaseline vs post surgery at 24 weeks. C4 weeks vs post surgery at 24 weeks. Lower case letters; p < 0.05, upper case letters; p < 0.01
Fig. 3
Fig. 3
NEFA and glycerol levels during OGTT in surgery and control group. a NEFA in surgery group; b NEFA in control group. Data are shown as mean ± 95% CI. a,ABaseline vs post surgery at 4 weeks. b,BBaseline vs post surgery at 24 weeks. Lower case letters; p < 0.05, upper case letters; p < 0.01
See this image and copyright information in PMC

References

    1. Schauer PR, Bhatt DL, Kashyap SR. Bariatric surgery or intensive medical therapy for diabetes after 5 years. N. Engl. J. Med. 2017;376(20):1997. doi: 10.1056/NEJMc1703377. - DOI - PubMed
    1. Mingrone G, Cummings DE. Changes of insulin sensitivity and secretion after bariatric/metabolic surgery. Surg. Obes. Relat. Dis. 2016;12(6):1199–1205. doi: 10.1016/j.soard.2016.05.013. - DOI - PubMed
    1. Batterham RL, Cummings DE. Mechanisms of diabetes improvement following bariatric/metabolic surgery. Diabetes Care. 2016;39(6):893–901. doi: 10.2337/dc16-0145. - DOI - PMC - PubMed
    1. Falken Y, Hellstrom PM, Holst JJ, Naslund E. Changes in glucose homeostasis after Roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery: role of gut peptides. J. Clin. Endocrinol. Metab. 2011;96(7):2227–2235. doi: 10.1210/jc.2010-2876. - DOI - PubMed
    1. Jorgensen NB, Jacobsen SH, Dirksen C, Bojsen-Moller KN, Naver L, Hvolris L, Clausen TR, Wulff BS, Worm D, Lindqvist Hansen D, Madsbad S, Holst JJ. Acute and long-term effects of Roux-en-Y gastric bypass on glucose metabolism in subjects with Type 2 diabetes and normal glucose tolerance. Am. J. Physiol. Endocrinol. Metab. 2012;303(1):E122–E131. doi: 10.1152/ajpendo.00073.2012. - DOI - PubMed

Publication types