Removal off Duodenum Elicits GLP-1 Secretion

• Autores: Giovanna Muscogiuri, Teresa Mezza, Annamaria Prioletta, Gian Pio Sorice, Gennaro Clemente
• Localización: Diabetes care, ISSN-e 0149-5992, Vol. 36, Nº. 6, 2013, págs. 1641-1646
• Idioma: inglés
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• Resumen

  • OBJECTIVE-To evaluate the effect of removal of the duodenum on the complex interplay between incretins, insulin, and glucagon in nondiabetic subjects.

    RESEARCH DESIGN AND METHODS-For evaluation of hormonal secretion and insulin sensitivity, 10 overweight patients without type 2 diabetes (age 61 ± 19.3 years and BMI 27.9 ± 5.3 kg/m^sup 2^) underwent a mixed-meal test and a hyperinsulinemic-euglycemic clamp before and after pylorus-preserving pancreatoduodenectomy for ampulloma.

    RESULTS-All patients experienced a reduction in insulin (P = 0.002), C-peptide (P = 0.0002), and gastric inhibitory peptide (GIP) secretion (P = 0.0004), while both fasting and postprandial glucose levels increased (P = 0.0001); GLP-1 and glucagon responses to the mixed meal increased significantly after surgery (P = 0.02 and 0.031). While changes in GIP levels did not correlate with insulin, glucagon, and glucose levels, the increase in GLP-1 secretion was inversely related to the postsurgery decrease in insulin secretion (R^sup 2^ = 0.56; P = 0.012) but not to the increased glucagon secretion, which correlated inversely with the reduction of insulin (R^sup 2^ = 0.46; p = 0.03) and C-peptide (R^sup 2^ = 0.37; P = 0.04). Given that the remaining pancreas presumably has preserved intraislet anatomy, insulin secretory capacity, and a- and ß-cell interplay, our data suggest that the increased glucagon secretion is related to decreased systemic insulin.

    CONCLUSIONS-Pylorus-preserving pancreatoduodenectomy was associated with a decrease in GIP and a remarkable increase in GLP-1 levels, which was not translated into increased insulin secretion. Rather, the hypoinsulinemia may have caused an increase in glucagon secretion.