Imperial College London
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Dr Alex Miras

Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

Visiting Professor
 
 
 
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Contact

 

+44 (0)7958 377 674a.miras

 
 
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Location

 

Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Miras:2021:10.2337/dc20-0762,
author = {Miras, A and Kamocka, A and Pérez-Pevida, B and Purkayastha, S and Moorthy, K and Patel, A and Chahal, H and Frost, G and Bassett, P and Castagnetto-Gissey, L and Coppin, L and Jackson, N and Umpleby, M and Bloom, S and Tan, T and Ahmed, A and Rubino, F},
doi = {10.2337/dc20-0762},
journal = {Diabetes Care},
pages = {1--9},
title = {The effect of standard versus longer intestinal bypass on GLP-1 regulation and glucose metabolism in patients with type 2 diabetes undergoing roux-en-Y gastric bypass. The long-limb study},
url = {http://dx.doi.org/10.2337/dc20-0762},
volume = {44},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - ObjectiveRoux-en-Y gastric bypass (RYGB) characteristically enhances post-prandial levels of Glucagon-like peptide 1 (GLP-1), a mechanism that contributes to its profound glucose-lowering effects. This enhancement is thought to be triggered by bypass of food to the distal small intestine with higher densities of neuroendocrine L-cells. We hypothesised that if this is the predominant mechanism behind the enhanced secretion of GLP-1, a longer intestinal bypass would potentiate the post-prandial peak in GLP-1, translating into higher insulin secretion and thus additional improvements in glucose tolerance. To investigate this, we conducted a mechanistic study comparing two variants of RYGB that differ in the length of intestinal bypass.Research Design and MethodsFifty-three patients with type 2 diabetes and obesity were randomised to either ‘standard limb’ RYGB (50cm biliopancreatic limb) or ‘long limb’ RYGB (150cm biliopancreatic limb). They underwent measurements of GLP-1 and insulin secretion following a mixed meal and insulin sensitivity using euglycaemic hyperinsulinaemic clamps at baseline, 2 weeks and at 20% weight loss after surgery.ResultsBoth groups exhibited enhancement in post-prandial GLP-1 secretion and improvements in glycaemia compared to baseline. There were no significant differences in post-prandial peak concentrations of GLP-1, time to peak, insulin secretion, and insulin sensitivity. ConclusionThe findings of this study demonstrate that lengthening of the intestinal bypass in RYGB does not affect GLP-1 secretion. Thus, the characteristic enhancement of GLP-1 response after RYGB might not depend on delivery of nutrients to more distal intestinal segments.
AU  - Miras,A
AU  - Kamocka,A
AU  - Pérez-Pevida,B
AU  - Purkayastha,S
AU  - Moorthy,K
AU  - Patel,A
AU  - Chahal,H
AU  - Frost,G
AU  - Bassett,P
AU  - Castagnetto-Gissey,L
AU  - Coppin,L
AU  - Jackson,N
AU  - Umpleby,M
AU  - Bloom,S
AU  - Tan,T
AU  - Ahmed,A
AU  - Rubino,F
DO  - 10.2337/dc20-0762
EP  - 9
PY  - 2021///
SN  - 0149-5992
SP  - 1
TI  - The effect of standard versus longer intestinal bypass on GLP-1 regulation and glucose metabolism in patients with type 2 diabetes undergoing roux-en-Y gastric bypass. The long-limb study
T2  - Diabetes Care
UR  - http://dx.doi.org/10.2337/dc20-0762
UR  - https://care.diabetesjournals.org/content/early/2020/11/05/dc20-0762
UR  - http://hdl.handle.net/10044/1/82386
VL  - 44
ER  -
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