Proinsulin associates with poor β‐cell function, glucose‐dependent insulinotropic peptide, and insulin resistance in persistent type 2 diabetes after Roux‐en‐Y gastric bypass in humans
| Autor: | Betsy Rojas, Michael Ahlers, Blandine Laferrère, Victoria Mark, Esmeralda Pierini, Ankit Shah, Kapila Patel, Kiarra Levesque |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Endocrinology Diabetes and Metabolism medicine.medical_treatment Gastric Bypass 030209 endocrinology & metabolism Type 2 diabetes 030204 cardiovascular system & hematology Glucagon Article Cohort Studies 03 medical and health sciences 0302 clinical medicine Insulin resistance Recurrence Insulin-Secreting Cells Internal medicine Diabetes mellitus medicine Humans Insulin Proinsulin C-Peptide business.industry Leptin Body Weight Glucose Tolerance Test Middle Aged medicine.disease Roux-en-Y anastomosis Cross-Sectional Studies Endocrinology Diabetes Mellitus Type 2 Female Insulin Resistance business |
| Zdroj: | Journal of Diabetes. 12:77-86 |
| ISSN: | 1753-0407 1753-0393 |
| DOI: | 10.1111/1753-0407.12964 |
| Popis: | The determinants of type 2 diabetes (T2D) remission and/or relapse after gastric bypass (RYGB) remain fully unknown. This study characterized β- and α-cell function, in cretin hormone release and insulin sensitivity in individuals with (remitters) or without (non-remitters) diabetes remission after RYGB.This is a cross-sectional study of two distinct cohorts of individuals with or without diabetes remission at least 2 years after RYGB. Each individual underwent-either an oral glucose (remitters) or a mixed meal (non-remitters) test; glucose, proinsulin, insulin, C-peptide, glucagon, incretins and leptin were measured.Compared to remitters (n = 23), non-remitters (n = 31) were older (mean [±SD] age 56.1 ± 8.2 vs. 46.0 ± 8.9 years, P 0.001), had longer diabetes duration (13.1 ± 10.1 vs. 2.2 ± 2.4 years, P 0.001), were further out from the surgery (5.6 ± 3.3 vs. 3.5 ± 1.7 years, P 0.01), were more insulin resistant (HOMA-IR 4.01 ± 3.65 vs. 2.08 ± 1.22, P 0.001), but did not differ for body weight. As predicted, remitters had higher β-cell glucose sensitivity (1.95 ± 1.23 vs. 0.86 ± 0.55 pmol/kg/min/mmol, P 0.001) and disposition index (1.55 ± 1.75 vs 0.33 ± 0.27, P = 0.003), compared to non-remitters, who showed non-suppressibility of glucagon during the oral challenge (time × group P = 0.001). Higher proinsulin (16.55 ± 10.45 vs. 6.62 ± 3.50 PM, P 0.0001), and proinsulin: C-peptide (40.83 ± 29.43 vs. 17.13 ± 7.16, P 0.001) were strongly associated with non-remission status, while differences in incretins between remitters and non-remitters were minimal.Individual without diabetes remission after gastric bypass have poorer β-cell response and lesser suppression of glucagon to an oral challenge; body weight and incretins differ minimally according to remission status.背景: 目前尚未完全明确2型糖尿病(T2D)患者接受胃旁路术(RYGB)后病情缓解或复发的决定因素。这项研究描述了RYGB术后糖尿病缓解或未缓解个体的β-与α-细胞功能、肠促胰岛素激素释放及胰岛素敏感性。 方法: 这是一项横断面研究, 对RYGB术后至少2年后糖尿病缓解或未缓解的不同队列个体进行了研究。每个个体均进行口服葡萄糖(缓解者)或者混合餐(非缓解者)耐量试验；测量血糖、胰岛素原、胰岛素、C肽、胰高血糖素、肠促胰岛素以及瘦素水平。 结果: 与缓解者(n=23)相比, 未缓解者(n=31)年龄更大(平均[±SD]年龄56.1±8.2 vs. 46.0±8.9岁, P0.001)、糖尿病病程更长(13.1±10.1 vs. 2.2±2.4年, P0.001)、距离手术时间更长(5.6±3.3 vs. 3.5±1.7年, P0.01)、胰岛素抵抗更严重(HOMA-IR为4.01±3.65 vs. 2.08±1.22, P0.001), 但体重无差异。正如预期, 与未缓解者相比, 缓解者具有较高的β细胞葡萄糖敏感性(1.95±1.23 vs. 0.86±0.55 pmol/kg/min/mmol, P0.001)以及处置指数(1.55±1.75 vs. 0.33±0.27, P=0.003), 后者在口服耐量试验期间的胰高血糖素水平并未受到抑制(时间×分组, P=0.001)。较高水平的胰岛素原(16.55±10.45 vs. 6.62±3.50PM, P0.0001)以及胰岛素原:C肽比值(40.83±29.43与17.13±7.16, P0.001)与未缓解状态密切相关, 但是缓解者与未缓解者之间的肠促胰岛素差异非常小。 结论: 胃旁路术后糖尿病无缓解的个体对口服耐量试验中β细胞的应答较差, 对胰高血糖素的抑制也较小；根据糖尿病缓解状态进行分组, 发现体重与肠促胰岛素的差异非常小。. |
| Databáze: | OpenAIRE |
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