First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY level changes 72 hrs after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis.

Mukesh Kumar Meena; Bh; ari M.; Varma M.; Shrivastav R. K.; Jain V. K.

First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY level changes 72 hrs after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis.

Author(s): Mukesh Kumar Meena*, Bhandari M., Varma M., Shrivastav R. K., Jain V. K.

Abstract

In diabetic patients who had the disease less than 10.5 years, the first phase of insulin secretion promptly improved after SG. The early insulin area under the curve (AUC) significantly increased at the postoperative IVGTT, indicating an increased glucose-induced insulin secretion. The second phase of insulin secretion (late AUC) significantly decreased after SG in all groups, indicating an improved insulin peripheral sensitivity. In all groups, pre- and postoperatively, intravenous glucose stimulation determined a decrease in ghrelin values and an increase in GLP-1 and PYY values. However, in the group of patients with disease duration >10.5 years, the differences were not significant except for the late insulin AUC. Postoperative basal and intravenous glucose-stimulated ghrelin levels were lower than preoperative levels in all groups of patients. Basal and intravenous stimulated GLP-1 and PYY postoperative values were higher than preoperative levels in all groups. Restoration of the first phase of insulin secretion and improved insulin sensitivity in diabetic obese patients immediately after SG, before any food passage through the gastrointestinal tract and before any weight loss, seem to be related to ghrelin, GLP-1, and PYY hormonal changes of possible gastric origin and was neither meal- nor weight-change-related. Duration of the disease up to 10.5 years seems to be a major cut off in the pathophysiological changes induced by SG. A "gastric" hypothesis may be put forward to explain the anti-diabetes effect of SG.

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