Skip to main content
SpringerLink
Log in

Gastric Emptying of Orally Administered Glucose Solutions and Incretin Hormone Responses Are Unaffected by Laparoscopic Adjustable Gastric Banding

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Laparoscopic adjustable gastric banding (LAGB) provides weight loss in obese individuals and is associated with improved glucose homeostasis and resolution of type 2 diabetes. However, in most available reports, potentially inappropriate methodology has been applied when measuring the impact of LAGB on glucose intolerance. In order to clarify the applicability of the diagnostic 75 g-oral glucose tolerance test (OGTT) to measure the effect of LAGB on glucose metabolism, we investigated the effect of LAGB on gastric emptying for liquids as well as pancreatic and incretin hormone responses.

Methods

Eight obese patients (three with normal glucose tolerance, three with impaired glucose tolerance, and two with type 2 diabetes; age 47.5 ± 1.1 years (mean±SEM); body mass index 44 ± 1 kg/m2; HbA1c 6.2 ± 0.4%) underwent a 75 g-oral glucose tolerance test with 1 g acetaminophen before and ~6 weeks after LAGB.

Results

A small weight reduction was seen after LAGB (125 ± 8 vs. 121 ± 8 kg, P = 0.014). No differences in determinants of gastric emptying were observed before and after LAGB (area under the serum acetaminophen curve 10.1 ± 0.6 vs. 9.8 ± 0.5 mM×4 h, P = 0.8; peak acetaminophen concentration 62 ± 3 vs. 61 ± 3 μM, P = 0.8; acetaminophen peak time 98 ± 6 vs. 100 ± 6 min, P = 0.9). No differences in plasma glucose, insulin, C-peptide, glucagon, glucose-dependent insulinotropic polypeptide, or glucagon-like peptide-1 responses to the OGTT were observed before as compared to after LAGB.

Conclusions

OGTT can be used to evaluate glucose tolerance in obese patients before and after LAGB without bias from changes in gastric emptying. LAGB has no direct impact on incretin hormone secretion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

AUC:

Area under curve

BMI:

Body mass index

FPG:

Fasting plasma glucose

GIP:

Glucose-dependent insulinotropic polypeptide

GLP-1:

Glucagon-like peptide-1

HbA1c:

Glycated hemoglobin A1c

HOMA:

The homeostatic model assessment

HOMAIR :

Insulin resistance according to HOMA

IGT:

Impaired glucose tolerance

LAGB:

Laparoscopic adjustable gastric banding

OGTT:

Oral glucose tolerance test

SEM:

Standard error of the mean

WHO:

World Health Organization

References

  1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diab Care. 2004;27(5):1047–53.

    Article  Google Scholar 

  2. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–53.

  3. Eriksson KF, Lindgarde F. Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmo feasibility study. Diabetologia. 1991;34(12):891–8.

    Article  PubMed  CAS  Google Scholar 

  4. Stunkard AJ. Conservative treatments for obesity. Am J Clin Nutr. 1987;45(5 Suppl):1142–54.

    PubMed  CAS  Google Scholar 

  5. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  PubMed  CAS  Google Scholar 

  6. Dixon JB, O'Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diab Care. 2002;25(2):358–63.

    Article  Google Scholar 

  7. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32 Suppl 1:S13–61.

    Article  Google Scholar 

  8. Greenway SE, Greenway 3rd FL, Klein S. Effects of obesity surgery on non-insulin-dependent diabetes mellitus. Arch Surg. 2002;137(10):1109–17.

    Article  PubMed  Google Scholar 

  9. Tiktinsky E, Lantsberg L, Lantsberg S, et al. Gastric emptying of semisolids and pouch motility following laparoscopic adjustable gastric banding. Obes Surg. 2009;19(9):1270–3.

    Article  PubMed  Google Scholar 

  10. Willems M, Quartero AO, Numans ME. How useful is paracetamol absorption as a marker of gastric emptying? A systematic literature study. Dig Dis Sci. 2001;46(10):2256–62.

    Article  PubMed  CAS  Google Scholar 

  11. Holst JJ. On the physiology of GIP and GLP-1. Horm Metab Res. 2004;36(11–12):747–54.

    Article  PubMed  CAS  Google Scholar 

  12. Chaikomin R, Doran S, Jones KL, et al. Initially more rapid small intestinal glucose delivery increases plasma insulin, GIP, and GLP-1 but does not improve overall glycemia in healthy subjects. Am J Physiol Endocrinol Metab. 2005;289(3):E504–7.

    Article  PubMed  CAS  Google Scholar 

  13. Schirra J, Katschinski M, Weidmann C, et al. Gastric emptying and release of incretin hormones after glucose ingestion in humans. J Clin Invest. 1996;97(1):92–103.

    Article  PubMed  CAS  Google Scholar 

  14. Bablok W, Passing H, Bender R, Schneider B. A general regression procedure for method transformation. Application of linear regression procedures for method comparison studies in clinical chemistry, part III. J Clin Chem Clin Biochem. 1988;26(11):783–90.

    PubMed  CAS  Google Scholar 

  15. Ørskov C, Jeppesen J, Madsbad S, Holst JJ. Proglucagon products in plasma of noninsulin-dependent diabetics and nondiabetic controls in the fasting state and after oral glucose and intravenous arginine. J Clin Invest. 1991;87(2):415–23.

    Article  PubMed  Google Scholar 

  16. Krarup T, Holst JJ. The heterogeneity of gastric inhibitory polypeptide in porcine and human gastrointestinal mucosa evaluated with five different antisera. Regul Pept. 1984;9(1–2):35–46.

    Article  PubMed  CAS  Google Scholar 

  17. Heading RC, Nimmo J, Prescott LF, Tothill P. The dependence of paracetamol absorption on the rate of gastric emptying. Br J Pharmacol. 1973;47(2):415–21.

    PubMed  CAS  Google Scholar 

  18. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.

    Article  PubMed  CAS  Google Scholar 

  19. Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diab Care. 1999;22(9):1462–70.

    Article  CAS  Google Scholar 

  20. Wareham NJ, Phillips DI, Byrne CD, Hales CN. The 30 minute insulin incremental response in an oral glucose tolerance test as a measure of insulin secretion. Diabet Med. 1995;12(10):931.

    Article  PubMed  CAS  Google Scholar 

  21. Kosaka K, Kuzuya T, Hagura R, Yoshinaga H. Insulin response to oral glucose load is consistently decreased in established non-insulin-dependent diabetes mellitus: the usefulness of decreased early insulin response as a predictor of non-insulin-dependent diabetes mellitus. Diabet Med. 1996;13(9 Suppl 6):S109–19.

    PubMed  CAS  Google Scholar 

  22. Kadowaki T, Miyake Y, Hagura R, et al. Risk factors for worsening to diabetes in subjects with impaired glucose tolerance. Diabetologia. 1984;26(1):44–9.

    Article  PubMed  CAS  Google Scholar 

  23. Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery. 2004;135(3):326–51.

    Article  PubMed  Google Scholar 

  24. Cunneen SA. Review of meta-analytic comparisons of bariatric surgery with a focus on laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2008;4(3 Suppl):S47–55.

    Article  PubMed  Google Scholar 

  25. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.

    PubMed  Google Scholar 

  26. Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diab Care. 2009;32(11):2133–5.

    Article  Google Scholar 

  27. Hanusch-Enserer U, Ghatei MA, Cauza E, Bloom SR, Prager R, Roden M. Relation of fasting plasma peptide YY to glucose metabolism and cardiovascular risk factors after restrictive bariatric surgery. Wien Klin Wochenschr. 2007;119(9–10):291–6.

    Article  PubMed  CAS  Google Scholar 

  28. Pontiroli AE, Folli F, Paganelli M, et al. Laparoscopic gastric banding prevents type 2 diabetes and arterial hypertension and induces their remission in morbid obesity: a 4-year case-controlled study. Diab Care. 2005;28(11):2703–9.

    Article  Google Scholar 

  29. Pontiroli AE, Gniuli D, Mingrone G. Early effects of gastric banding (LGB) and of biliopancreatic diversion (BPD) on insulin sensitivity and on glucose and insulin response after OGTT. Obes Surg. 2010;20(4):474–9.

    Article  PubMed  Google Scholar 

  30. Parkman HP, Harris AD, Krevsky B, Urbain JL, Maurer AH, Fisher RS. Gastroduodenal motility and dysmotility: an update on techniques available for evaluation. Am J Gastroenterol. 1995;90(6):869–92.

    PubMed  CAS  Google Scholar 

  31. Vantrappen G. Methods to study gastric emptying. Dig Dis Sci. 1994;39(12 Suppl):91S–4S.

    PubMed  CAS  Google Scholar 

  32. de Jong JR, Besselink MG, van Ramshorst B, Gooszen HG, Smout AJ. Effects of adjustable gastric banding on gastroesophageal reflux and esophageal motility: a systematic review. Obes Rev. 2010;11(4):297–305.

    Article  PubMed  Google Scholar 

  33. Hladik P, Vizda J, Mala E, Zadak Z, Hroch T. The contribution of gastric emptying scintigraphy to the treatment of obesity with gastric bandage—preliminary results. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2008;152(1):125–8.

    PubMed  Google Scholar 

  34. Horowitz M, Collins PJ, Harding PE, Shearman DJ. Abnormalities of gastric emptying in obese patients. Gastroenterology. 1983;85(4):983–5.

    PubMed  CAS  Google Scholar 

  35. Wright RA, Krinsky S, Fleeman C, Trujillo J, Teague E. Gastric emptying and obesity. Gastroenterology. 1983;84(4):747–51.

    PubMed  CAS  Google Scholar 

  36. Bertin E, Schneider N, Abdelli N, et al. Gastric emptying is accelerated in obese type 2 diabetic patients without autonomic neuropathy. Diab Metab. 2001;27(3):357–64.

    CAS  Google Scholar 

  37. Pacini G, Mari A. Methods for clinical assessment of insulin sensitivity and beta-cell function. Best Pract Res Clin Endocrinol Metab. 2003;17(3):305–22.

    Article  PubMed  CAS  Google Scholar 

  38. Nauck MA, Homberger E, Siegel EG, et al. Incretin effects of increasing glucose loads in man calculated from venous insulin and C-peptide responses. J Clin Endocrinol Metab. 1986;63(2):492–8.

    Article  PubMed  CAS  Google Scholar 

  39. Vilsbøll T, Krarup T, Madsbad S, Holst JJ. Both GLP-1 and GIP are insulinotropic at basal and postprandial glucose levels and contribute nearly equally to the incretin effect of a meal in healthy subjects. Regul Pept. 2003;114(2–3):115–21.

    Article  PubMed  Google Scholar 

  40. Flint A, Raben A, Astrup A, Holst JJ. Glucagon-like peptide 1 promotes satiety and suppresses energy intake in humans. J Clin Invest. 1998;101(3):515–20.

    Article  PubMed  CAS  Google Scholar 

  41. Le Roux CW, Welbourn R, Werling M, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246(5):780–5.

    Article  PubMed  Google Scholar 

  42. Bose M, Machineni S, Olivan B, et al. Superior appetite hormone profile after equivalent weight loss by gastric bypass compared to gastric banding. Obesity (Silver Spring). 2010;18(6):1085–91.

    Article  CAS  Google Scholar 

  43. Korner J, Inabnet W, Febres G, et al. Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass. Int J Obes (Lond). 2009;33(7):786–95.

    Article  CAS  Google Scholar 

Download references

Acknowledgments

We thank all participants for spending time on this project and we are grateful for the technical assistance of Helle Lethmer, Lisbeth Andreasen, Marlene Rohr, Sofie Pilgaard, and Lene Albæk. This work was made possible by an EFSD/Novartis research grant.

Conflict of Interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Internal Medicine M, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark

    Lotte Usinger & Steen Larsen

  2. Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark

    Katrine B. Hansen

  3. Department of Gastroenterology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark

    Viggo B. Kristiansen

  4. Diabetes Research Division, Department of Internal Medicine F, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Copenhagen, Denmark

    Filip K. Knop

  5. Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Copenhagen, Denmark

    Jens J. Holst

Authors
  1. Lotte Usinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katrine B. Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Viggo B. Kristiansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steen Larsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jens J. Holst
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Filip K. Knop
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Filip K. Knop.

Additional information

Lotte Usinger and Katrine B. Hansen contributed equally to the present work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Usinger, L., Hansen, K.B., Kristiansen, V.B. et al. Gastric Emptying of Orally Administered Glucose Solutions and Incretin Hormone Responses Are Unaffected by Laparoscopic Adjustable Gastric Banding. OBES SURG 21, 625–632 (2011). https://doi.org/10.1007/s11695-011-0362-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-011-0362-9

Keywords

Search

Navigation