Exenatide challenge in oral glucose tolerance test is insufficient for predictions of glucose metabolism and insulin secretion after sleeve gastrectomy (SG) in obese patients with type 2 diabetes: a pilot study to establish a preoperative model to estimate β-cell function following augmented glucagon-like peptide-1 secretion after SG

The postoperative increase in glucagon-like peptide-1 (GLP-1) is the main factor to improve glucose metabolism following sleeve gastrectomy (SG) in obese patients with type 2 diabetes. We investigated whether the β-cell responsiveness to an injection of exogenous GLP-1 in the preoperative period cou...

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Bibliographic Details
Published in:Endocrine Journal 2022, Vol.69(12), pp.1457-1465
Main Authors: Nakamura, Yuta, Horie, Ichiro, Kanetaka, Kengo, Eguchi, Susumu, Nakamichi, Seiko, Hongo, Ryoko, Takashima, Miwa, Kawakami, Atsushi, Abiru, Norio
Format: Article
Language:English
Subjects:
Blood Glucose - metabolism
Diabetes Mellitus, Type 2 - metabolism
Exenatide
Gastrectomy - methods
Glucagon-Like Peptide 1
Glucose
Glucose Tolerance Test
Hindgut hypothesis
Humans
Insulin - metabolism
Insulin Secretion
Obesity - complications
Obesity - surgery
Pilot Projects
Sleeve gastrectomy
Type 2 diabetes
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Summary:The postoperative increase in glucagon-like peptide-1 (GLP-1) is the main factor to improve glucose metabolism following sleeve gastrectomy (SG) in obese patients with type 2 diabetes. We investigated whether the β-cell responsiveness to an injection of exogenous GLP-1 in the preoperative period could determine the postoperative glucose tolerance in 18 patients underwent SG. In the preoperative period, a regular oral glucose tolerance test (OGTT) and an exenatide-challenge during OGTT (Ex-OGTT) were performed to evaluate the β-cell function and its responsiveness to GLP-1. The postoperative glucose tolerance was evaluated by another regular OGTT performed at 3 months after SG. The significant decrease in glucose levels with enhanced secretions of insulin and GLP-1 was observed in OGTT at 3 months after SG. The area under the curve of glucose from 0 to 120 minutes (AUC glucose0–120 min) and the insulinogenic index (I.I.) in OGTT at 3 months post-SG were significantly improved compared to those in preoperative period, but comparable with those in Ex-OGTT. AUC glucose0–120 min and I.I. in OGTT at 3 months post-SG were significantly correlated with not only those in Ex-OGTT, but also those in the preoperative regular OGTT. Conversely, the correlations calculated by the Spearman’s ρ were stronger in the latter than the former. This exenatide-challenge protocol might be useful to estimate glucose tolerance and insulin secretion after SG, however, it may be insufficient to improve predictability of a patient who is likely to achieve a significant benefit on glucose metabolism from receiving SG.
ISSN:0918-8959
1348-4540
DOI:10.1507/endocrj.EJ22-0224