The role of glucagon-like peptide 1 in the remission of type 2 diabetes mellitus in obese patients after metabolic surgery
AbstractMetabolic surgery has become widespread in recent years due to its high efficiency in the treatment not only of morbid obesity, but also of type 2 diabetes mellitus (T2DM). A decrease in glycemia in patients after bariatric surgery is observed long before a significant reduction in body weight, which suggests mechanisms that do not depend on weight loss and contribute to improving glycemic control. The role of incretin hormones in the carbohydrate metabolism normalization after metabolic surgery is discussed, however, there is currently no convincing literature data on the contribution of glucagon-like peptide‑1 (GLP‑1) to the development of T2DM remission. It seems relevant to study the role of GLP‑1 in achieving and maintaining remission of T2DM in patients after metabolic surgery.
The purpose of the study is to study the role of GLP‑1 in achieving and maintaining remission of T2DM in patients after metabolic surgery.
Material and methods. An observational prospective study was conducted: 193 patients with a body mass index (BMI) ≥30 kg/m2 aged 18 to 69 years, who underwent bariatric surgery for the first time: sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Patients with T2DM accounted for 39,9% of the total group (n=77, 53 women, 24 men), SG was performed in 46 patients, RYGB – in 31 patients. At baseline and during the follow-up period (1–3 years) anthropometric data HbA1c, insulin, fasting plasma glucose and the insulin resistance index (HOMA-IR) were assessed. Also the level of stimulated GLP‑1 was assessed in all patients at baseline, on the 3rd day after metabolic surgery and 1–3 years after it (plateau phase). During the postoperative period the criteria for remission of T2DM were evaluated in patients. The data obtained were compared in patients with T2DM and obesity, in patients without T2DM, as well as in patients after various bariatric operations (SG and RYGB).
Results. Stimulated secretion of GLP‑1 in patients with T2DM and obesity was significantly lower at baseline than in patients with obesity without T2DM and in healthy control group. On the 3rd day after bariatric surgery there was a significant increase in the level of GLP‑1 in the test with “standard food” in both SG and RYGB groups. Achieving and maintaining remission of T2DM in bariatric patients did not depend on the dynamics of stimulated GLP‑1 level. Stimulated secretion of GLP‑1 significantly increased on the 3rd day after surgical treatment and remained at the achieved level in plateau phase. Sleeve gastrectomy and Roux-en-Y gastric bypass are comparable in the dynamics of stimulated GPP‑1 (on day 3 and in the plateau phase), as well as in achieving remission of T2DM.
Keywords:bariatric surgery; remission of diabetes mellitus; sleeve gastrectomy; Roux-en-Y; gastric bypass
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Mozgunova V.S., Semikova G.V., Volkova A.R., Khalimov Yu.Sh., Monarshenko A.V., Vasilevskiy D.I., Anisimova K.A., Balandov S.G. The role of glucagon-like peptide‑1 in the remission of type 2 diabetes mellitus in obese patients after metabolic surgery. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2023; 12 (4): 28–34. DOI: https://doi.org/10.33029/2304-9529-2023-12-4-28-34 (in Russian)
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