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Early Changes in Adipose Tissue Morphology, Gene Expression, and Metabolism After RYGB in Patients With Obesity and T2D.
- Source :
-
The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2019 Jul 01; Vol. 104 (7), pp. 2601-2613. - Publication Year :
- 2019
-
Abstract
- Context: Roux-en-Y gastric bypass (RYGB) surgery effectively prevents or treats type 2 diabetes (T2D). Adipose tissue (AT) mechanisms may be of importance.<br />Objective: To assess the relationship between early changes in whole-body and AT metabolism in surgically treated patients with T2D.<br />Design and Setting: A randomized single-center study.<br />Patients: Nineteen patients with T2D with body mass index 30 to 45 kg/m2.<br />Interventions: Thirteen patients were assessed at baseline and 4 and 24 weeks after RYGB (preceded by a 4-week low-calorie diet) and compared with 6 control patients continuing standard medical treatment: oral glucose tolerance test, subcutaneous AT biopsies for gene expression, adipocyte size, glucose uptake, lipolysis, and insulin action.<br />Results: At 4 and 24 weeks post-RYGB, all patients but one had stopped diabetes medication. Fasting glucose, HbA1c, and insulin levels decreased and the Matsuda index increased compared with baseline (P < 0.01 for all), indicating improved whole-body insulin sensitivity. Mean adipocyte size significantly reduced, more at 4 than at 24 weeks; at 4 weeks, glucose uptake per adipocyte was lowered, and isoproterenol-stimulated lipolysis tended to increase, whereas the fold insulin effects on glucose uptake and lipolysis were unchanged. Expression of genes involved in fatty acid oxidation, CPT1b and adiponectin, was increased at 4 weeks, whereas leptin and E2F1 (involved in cell proliferation) were reduced (P < 0.05 for all).<br />Conclusion: Glycemic control and in vivo insulin sensitivity improved 4 weeks after RYGB, but adipocyte insulin sensitivity did not change despite a marked reduction in adipocyte size. Thus, mechanisms for a rapid improvement of T2D after RYGB may occur mainly in other tissues than adipose.<br /> (Copyright © 2019 Endocrine Society.)
- Subjects :
- Adipocytes metabolism
Adult
Biopsy
Blood Glucose analysis
Blood Glucose metabolism
Diabetes Mellitus, Type 2 blood
Diabetes Mellitus, Type 2 etiology
Diabetes Mellitus, Type 2 metabolism
Female
Follow-Up Studies
Humans
Insulin metabolism
Insulin Resistance
Male
Middle Aged
Obesity, Morbid blood
Obesity, Morbid complications
Obesity, Morbid metabolism
Subcutaneous Fat, Abdominal cytology
Subcutaneous Fat, Abdominal pathology
Treatment Outcome
Diabetes Mellitus, Type 2 surgery
Gastric Bypass
Obesity, Morbid surgery
Subcutaneous Fat, Abdominal metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1945-7197
- Volume :
- 104
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- The Journal of clinical endocrinology and metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 30689903
- Full Text :
- https://doi.org/10.1210/jc.2018-02165