Incretin influence on type 2 diabetes mellitus remission after Roux-en-Y gastric bypass

BACKGROUND: Roux-en-Y gastric bypass promotes weight loss in patients with severe obesity and improves type 2 diabetes mellitus, which, in some cases, can lead to remission. The action of enteric hormones is relevant for the initial outcomes and late disease evolution. AIMS: To evaluate the influence of enteric hormone secretion on the evolution of type 2 diabetes mellitus three years after Roux-en-Y gastric bypass. METHODS: A total of 20 patients were evaluated, divided into 2 groups: group 1, glycated hemoglobin<6%, and group 2, glycated hemoglobin≥6%. Hormone secretion (ghrelin, GLP-1, and GIP) was analyzed at pre-specified time points following a standard meal. RESULTS: Group 1 had higher mean secretion at 30 and 120 minutes ([992.60±806.78 vs. 407.97±186.80, p=0.039, p<0.05] and [418.72±219.11 vs. 240.14±121.11, p=0.037, p<0.05], respectively) than group 2. Group 1 presented higher GLP values at 60 [724 (195-1,483) vs. 214 (67-424), p=0.038, p<0.05], 90 [473 (200-943) vs. 180 (120-318), p=0.016, p<0.05] and 120 minutes [565 (278-770) vs. 163 (81-339), p=0.008, p<0.05] compared to group 2. There was no difference between the groups regarding ghrelin. CONCLUSIONS: Higher secretion of GIP and GLP-1 was observed in patients with type 2 diabetes mellitus remission. The incretin factor is important in late disease evolution even in a group of patients with severe diabetes.