Insulin Sensitivity and 尾-Cell Function Improve after Gastric Bypass in Severely Obese Adolescents

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• 作者：Thomas H. Inge ; MD ; PhD¹ ; ^{thomas.inge@cchmc.org" class="auth_mail" title="E-mail the corresponding author} ; Ronald L. Prigeon ; MD² ; Deborah A. Elder ; MD¹ ; Todd M. Jenkins ; PhD¹ ; Robert M. Cohen ; MD³ ; Stavra A. Xanthakos ; MD ; MS¹ ; Stephen C. Benoit ; PhD³ ; Lawrence M. Dolan ; MD¹ ; Stephen R. Daniels ; MD ; PhD⁴ ; David A. D'Alessio ; MD⁵ ; ⁶
• 关键词：AIRG ; Acute insulin response to glucose ; BMI ; Body mass index ; CP ; C-peptide ; DI ; Disposition index ; IR ; Insulin resistance ; IV ; Intravenous ; IVGTT ; Intravenous glucose tolerance test ; PI ; Proinsulin ; RYGB ; Roux-en-Y gastric bypass ; SI ; Insulin sensitivity index ; T2DM ; Type 2 diabetes mellitus
• 刊名：The Journal of Pediatrics
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：167
• 期：5
• 页码：1042-1048.e1
• 全文大小：451 K

文摘

To test the hypothesis that insulin secretion and insulin sensitivity would be improved in adolescents after Roux-en-Y gastric bypass (RYGB).

Study design

A longitudinal study of 22 adolescents and young adults without diabetes undergoing laparoscopic RYGB (mean age 17.1 ± 1.42 years; range 14.5-20.1; male/female 8/14; Non-Hispanic White/African American 17/5) was conducted. Intravenous glucose tolerance tests were done to obtain insulin sensitivity (insulin sensitivity index), insulin secretion (acute insulin response to glucose ), and the disposition index as primary outcome variables. These variables were compared over the 1 year of observation using linear mixed modeling.

Results

In the 1-year following surgery, body mass index fell by 38% from a mean of 61 ± 12.3 to 39 ± 8.0 kg/m² (P < .01). Over the year following surgery, fasting glucose and insulin values declined by 54% and 63%, respectively. Insulin sensitivity index increased 300% (P < .01), acute insulin response to glucose decreased 56% (P < .01), leading to a nearly 2-fold increase in the disposition index (P < .01). Consistent with improved 尾-cell function, the proinsulin to C-peptide ratio decreased by 21% (P < .01).

Conclusions

RYGB reduced body mass index and improved both insulin sensitivity and 尾-cell function in severely obese teens and young adults. These findings demonstrate that RYGB is associated with marked metabolic improvements in obese young people even as significant obesity persists.

Trial registration

ClinicalTrials.gov: NCT00360373.