Beta-cell sensitivity to glucose is impaired after gastric bypass surgery

Aims: Patients who have undergone Roux-en-Y gastric bypass surgery (GB) have exaggerated postprandial insulin secretion, which has been attributed to increased meal glucose appearance and enhanced incretin effect. Here, we sought to determine beta-cell glucose sensitivity in the absence of meal stimulation and insulinotropic gut factors. Materials and methods: A total of 12 non-diabetic subjects with prior GB, and 7 matched non-surgical control subjects with normal glucose tolerance were studied. Blood glucose and insulin secretion rates were measured during a graded glucose infusion at increasing and then decreasing rates. Insulin sensitivity (S-I) and glucose effectiveness (S-G) were determined by the minimal model. Results: GB subjects had S-I comparable to that of control subjects. GB subjects had relative hyperglycaemia during the highest dose of glucose infusion associated with significantly reduced beta-cell glucose sensitivity throughout both step-up (GB: 34 6, CN: 82 +/- 9 pmolmin(-1) mM(-1) L, P < .0001) and step-down (GB: 31 +/- 6, CN: 74 +/- 9 pmol min(-1) mM(-1) L, P < .0001) phases of the glucose infusion. GB subjects also had reduced S-G (GB: 0.04 +/- 0.00, CN: 0.07 +/- 0.01min(-1), P=.004). Conclusion: In the absence of enteric stimuli, beta-cell sensitivity to changes in g(l)ycaemia is blunted among individuals with GB, indicating a significant shift in a fundamental property of beta-cell function several years after surgery