题名：Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass.
作者：BOJSEN-MOLLER KN; DIRKSEN C; JORGENSEN NB; JACOBSEN SH; SERUP AK; ALBERS PH; HANSEN DL; WORM D; NAVER L; KRISTIANSEN VB; WOJTASZEWSKI JF; KIENS B; HOLST JJ; RICHTER EA; MADSBAD S;
来源：Diabetes. 2013 Nov 15. [ IF= 7.89 ] ]
摘要：Roux-en-Y gastric bypass (RYGB) improves glycemic control within days after
surgery, and changes in insulin sensitivity and beta-cell function are likely to
be involved. We studied 10 obese patients with type 2 diabetes and 10 obese
glucose tolerant subjects before, 1 week, 3 months and 1 year after RYGB.
Participants were included after a preoperative diet induced total weight loss of
-9.2+/-1.2%. Hepatic and peripheral insulin sensitivity were assessed using the
hyperinsulinemic euglycemic clamp combined with glucose tracer technique and
beta-cell function evaluated in response to an intravenous glucose-glucagon
challenge as well as an oral glucose load. Already within 1 week, RYGB reduced
basal glucose production, improved basal hepatic insulin sensitivity and
increased insulin clearance highlighting the liver as an important organ
responsible for the early effects on glucose metabolism after surgery. Insulin
mediated glucose disposal and suppression of fatty acids did not improve
immediately after surgery but increased at 3 months and 1 year likely related to
the reduction in body weight. Insulin secretion increased after RYGB, but only in
patients with type 2 diabetes and only in response to oral glucose, underscoring
the importance of the changed gut anatomy.