Sustained elevation of postprandial GLP-1 after bariatric surgery
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The incidence of obesity is on the rise globally and is associated with many comorbidities, especially type 2 diabetes mellitus (T2DM). Bariatric surgery is the most effective intervention for weight loss and reducing obesity-associated morbidity. The most common bariatric surgeries are roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). RYGB and SG are equally efficacious at long-term reduction of weight in obese individuals and amelioriation of T2DM. Interestingly, the improvement of glucose regulation is noted before weight loss is observed. The most likely mechanism underlying glucose homeostasis after bariatric surgery is hormonal changes in the intestine. Enteroendrocrine changes favorable of an anti-diabetic profile are noted after only a few days of receiving either RYGB or SG surgery. Most consistently, elevated postprandial GLP-1, a potent regulator of appetite and glucose control, is observed in post-bariatric surgery patients. However, data is limited regarding post-prandial GLP-1 levels beyond two years after surgery. This study will address the gap in literature by assessing postprandial elevations of GLP-1 following RYGB or SG for up to five years. We will recruit obese type-2 diabetics from an outpatient bariatric surgery clinic at Boston Medical Center scheduled to receive RYGB or SG and periodically assess postprandial GLP-1 levels to determine if they remain elevated after 5 years. Additionally, we will provide evidence if there is a correlation among changes in postprandial GLP-1, weight loss, and hemoglobin A1c at five years. Our proposed study will help direct researchers to develop safer and more efficacious interventions for obesity and T2DM.