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Liver and RYGB

Liver key to insulin clearance post-gastric bypass surgery

Post-operative insulin secretion may be underestimated in type 2 diabetics when evaluated by peripheral insulin concentrations

The liver is key to insulin clearance within one week bypass surgery, according to new research from Hvidovre Hospital and the University of Copenhagen, Denmark. The research published online in the Journal of Clinical Endocrinology & Metabolism, also noted that postprandial insulin secretion may be underestimated postoperatively in patients with type 2 diabetes when evaluated by peripheral insulin concentrations instead of insulin secretion rates or C-peptide.

Although it is known that RYGB improves glucose tolerance and aids fasting hyperinsulinemia within days after surgery, the investigators wanted to assess the contribution of insulin clearance in effecting these changes.

The prospective study looked at fasting hepatic insulin clearance and, in a subgroup of patients, postprandial insulin clearance after a meal test before and one week, three months, and one year after gastric bypass surgery.

To assess the changes, the 64 patients were separated into two groups: 1) type 2 diabetes (T2D) group (n= 32, meal test, n=13), 2) normal glucose tolerance (NGT) group (n=32, meal test, n=12).

Six patients did not complete the 1-week study due to postoperative complications, but all completed the three-month follow-up (except one patient who violated the fasting requirement. One patient (NGT group) was excluded due to pregnancy.


The results revealed that fasting hepatic insulin clearance increased after one week (p<0.01) and also at three months (p<0.01), remaining elevated one year postoperatively (p<0.01) with no difference between the T2D and NGT groups.

Whereas, postprandial insulin clearance changed in the T2D group with an increase at one week (p<0.01) that was maintained at three months (p=0.06) and one year (p<0.01).

Compared with fasting insulin clearance, postprandial clearance was reduced at all time points in both groups (0<0.01, all comparisons) with the exception of one week postoperatively in the T2D group (p=0.11).

“RYGB increases fasting hepatic insulin clearance within one week postoperatively in both patients with type 2 diabetes and NGT, highlighting the liver as a key organ involved in the early improvement in fasting glucose metabolism after surgery,” the authors conclude. “Three months postoperatively fasting hepatic insulin clearance is further enhanced and the improvement is sustained for at least one year. Furthermore, postprandial insulin clearance is increased in patients with type 2 diabetes already one week after RYGB.”

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