FGF 19 and Bile Acids Increase Following Roux-en-Y Gastric Bypass but Not After Medical Management in Patients with Type 2 Diabetes

Saachi Sachdev, Qi Wang, Charles Billington, John Connett, Leaque Ahmed, William Inabnet, Streamson C. Chua, Jr., Sayeed Ikramuddin, Judith Korner

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background: This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment. Methods: Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n = 15) or RYGB (n = 15). Results: Mean HbA1c decreased from 9.7 to 6.4 % after RYGB and from 9.1 to 6.1 % in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5 ± 0.5) was less than in the IMM group (4.6 ± 0.3). After RYGB, FGF19 increased in the fasted (93 ± 15 to 152 ± 19 pg/ml; P = 0.008) and postprandial states (area under the curve (AUC), 10.8 ± 1.9 to 23.4 ± 4.1 pg × h/ml × 10<sup>3</sup>; P = 0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×10<sup>3</sup>, 6.63 ± 1.3 to 15.16 ± 2.56 μM × h; P = 0.003) and decreased after IMM (AUC ×10<sup>3</sup>, 8.22 ± 1.24 to 5.70 ± 0.70; P = 0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r = 0.54, P = 0.04) and trended negatively with HbA1c (r = −0.44; P = 0.09); these associations were not observed after IMM. Conclusions: BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.

Original languageEnglish (US)
JournalObesity Surgery
DOIs
StateAccepted/In press - Aug 11 2015

Fingerprint

Gastric Bypass
Bile Acids and Salts
Type 2 Diabetes Mellitus
Fibroblast Growth Factors
Area Under Curve
Meals
Homeostasis
Glucose

Keywords

  • Bile acids
  • Fibroblast growth factor 19
  • Glucagon-like peptide-1
  • Roux-en-Y gastric bypass
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

FGF 19 and Bile Acids Increase Following Roux-en-Y Gastric Bypass but Not After Medical Management in Patients with Type 2 Diabetes. / Sachdev, Saachi; Wang, Qi; Billington, Charles; Connett, John; Ahmed, Leaque; Inabnet, William; Chua, Jr., Streamson C.; Ikramuddin, Sayeed; Korner, Judith.

In: Obesity Surgery, 11.08.2015.

Research output: Contribution to journalArticle

Sachdev, Saachi ; Wang, Qi ; Billington, Charles ; Connett, John ; Ahmed, Leaque ; Inabnet, William ; Chua, Jr., Streamson C. ; Ikramuddin, Sayeed ; Korner, Judith. / FGF 19 and Bile Acids Increase Following Roux-en-Y Gastric Bypass but Not After Medical Management in Patients with Type 2 Diabetes. In: Obesity Surgery. 2015.
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abstract = "Background: This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment. Methods: Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n = 15) or RYGB (n = 15). Results: Mean HbA1c decreased from 9.7 to 6.4 {\%} after RYGB and from 9.1 to 6.1 {\%} in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5 ± 0.5) was less than in the IMM group (4.6 ± 0.3). After RYGB, FGF19 increased in the fasted (93 ± 15 to 152 ± 19 pg/ml; P = 0.008) and postprandial states (area under the curve (AUC), 10.8 ± 1.9 to 23.4 ± 4.1 pg × h/ml × 103; P = 0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×103, 6.63 ± 1.3 to 15.16 ± 2.56 μM × h; P = 0.003) and decreased after IMM (AUC ×103, 8.22 ± 1.24 to 5.70 ± 0.70; P = 0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r = 0.54, P = 0.04) and trended negatively with HbA1c (r = −0.44; P = 0.09); these associations were not observed after IMM. Conclusions: BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.",
keywords = "Bile acids, Fibroblast growth factor 19, Glucagon-like peptide-1, Roux-en-Y gastric bypass, Type 2 diabetes mellitus",
author = "Saachi Sachdev and Qi Wang and Charles Billington and John Connett and Leaque Ahmed and William Inabnet and {Chua, Jr.}, {Streamson C.} and Sayeed Ikramuddin and Judith Korner",
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T1 - FGF 19 and Bile Acids Increase Following Roux-en-Y Gastric Bypass but Not After Medical Management in Patients with Type 2 Diabetes

AU - Sachdev, Saachi

AU - Wang, Qi

AU - Billington, Charles

AU - Connett, John

AU - Ahmed, Leaque

AU - Inabnet, William

AU - Chua, Jr., Streamson C.

AU - Ikramuddin, Sayeed

AU - Korner, Judith

PY - 2015/8/11

Y1 - 2015/8/11

N2 - Background: This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment. Methods: Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n = 15) or RYGB (n = 15). Results: Mean HbA1c decreased from 9.7 to 6.4 % after RYGB and from 9.1 to 6.1 % in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5 ± 0.5) was less than in the IMM group (4.6 ± 0.3). After RYGB, FGF19 increased in the fasted (93 ± 15 to 152 ± 19 pg/ml; P = 0.008) and postprandial states (area under the curve (AUC), 10.8 ± 1.9 to 23.4 ± 4.1 pg × h/ml × 103; P = 0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×103, 6.63 ± 1.3 to 15.16 ± 2.56 μM × h; P = 0.003) and decreased after IMM (AUC ×103, 8.22 ± 1.24 to 5.70 ± 0.70; P = 0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r = 0.54, P = 0.04) and trended negatively with HbA1c (r = −0.44; P = 0.09); these associations were not observed after IMM. Conclusions: BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.

AB - Background: This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment. Methods: Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n = 15) or RYGB (n = 15). Results: Mean HbA1c decreased from 9.7 to 6.4 % after RYGB and from 9.1 to 6.1 % in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5 ± 0.5) was less than in the IMM group (4.6 ± 0.3). After RYGB, FGF19 increased in the fasted (93 ± 15 to 152 ± 19 pg/ml; P = 0.008) and postprandial states (area under the curve (AUC), 10.8 ± 1.9 to 23.4 ± 4.1 pg × h/ml × 103; P = 0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×103, 6.63 ± 1.3 to 15.16 ± 2.56 μM × h; P = 0.003) and decreased after IMM (AUC ×103, 8.22 ± 1.24 to 5.70 ± 0.70; P = 0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r = 0.54, P = 0.04) and trended negatively with HbA1c (r = −0.44; P = 0.09); these associations were not observed after IMM. Conclusions: BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.

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KW - Fibroblast growth factor 19

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KW - Type 2 diabetes mellitus

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