Gut hormone secretion in a new meal tolerance test on insulin, glucagon, and glycemic excursions in patients with morbid obesity undergone sleeve gastrectomy

May 26, 2025American journal of physiology. Endocrinology and metabolism

Gut hormone release during a new meal test and its links to insulin, glucagon, and blood sugar changes in severely obese patients after stomach surgery

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Abstract

A mixed meal tolerance test significantly reduced reactive hypoglycemia in 30 post-laparoscopic sleeve gastrectomy patients.

Post-laparoscopic sleeve gastrectomy patients experienced reactive hypoglycemia during a standard oral glucose tolerance test.
Enhanced secretion of gut hormones glicentin and GLP-1 was associated with postprandial hypoglycemia linked to increased insulin and decreased glucagon during the oral glucose tolerance test.
A mixed meal tolerance test resulted in lower insulin secretion and increased glucagon and GIP levels, which helped prevent hypoglycemia.
The secretion of GIP during the oral glucose tolerance test showed no correlation with insulin secretion, and baseline GIP levels correlated positively with insulin resistance in both pre- and post-LSG patients.
Glucose-induced glicentin and GLP-1 secretions may contribute to postprandial hypoglycemia through overstimulation of insulin in post-LSG patients.

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We have reported that hypoglycemia during a 75-g oral glucose tolerance test (OGTT) in patients who underwent a laparoscopic sleeve gastrectomy (LSG) is prevented by a new mixed meal tolerance test (MTT) containing lipid, protein, and carbohydrate equivalent to 75-g glucose. We investigated whether the secretions of gut hormones, including glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glicentin during OGTT, were involved in reactive hypoglycemia observed in post-LSG patients through changes in plasma insulin and glucagon secretions. Thus, we compared these gut hormone secretions during the OGTT and MTT in 30 Japanese patients pre- and 1-yr post-LSG. Both GLP-1 and glicentin secretions were glucose-dependently stimulated in pre-LSG patients and were enhanced by the LSG. This enhancement was associated with postprandial hypoglycemia through both enhanced acute insulin secretion and suppressed glucagon secretion during the OGTT in the post-LSG patients whose calculated disposition index improved. Conversely, the MTT in the post-LSG patients attenuated the insulin secretion and enhanced both GIP and glucagon secretions, resulting in protection of hypoglycemia. The GIP secretion was stimulated during the OGTT without association with insulin secretion, and the baseline GIP levels were positively correlated with HOMA-R in both pre- and post-LSG patients. In conclusion, the glucose-induced glicentin and GLP-1 secretions were associated with glucose-induced postprandial hypoglycemia through an overstimulation of acute insulin secretion in post-LSG patients. The new MTT is useful to evaluate normalization of glucose tolerance through attenuation of glucose-stimulated glicentin and GLP-1 secretions and enhanced GIP and glucagon secretions in post-LSG patients.In postlaparoscopic sleeve gastrectomy (LSG) patients with enhanced disposition index, the standard OGTT resulted in postprandial reactive hypoglycemia, precluding accurate assessment of glucose tolerance. Glucose-induced glicentin and GLP-1 secretions were implicated in this phenomenon. However, a mixed meal test using 75-g carbohydrate, fat, and protein attenuated such reactive hypoglycemia, providing an accurate assessment of glucose tolerance through attenuation of both glicentin and GLP-1 oversecretions and enhanced GIP and glucagon secretions in post-LSG patients. NEW & NOTEWORTHY

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Gut hormone secretion in a new meal tolerance test on insulin, glucagon, and glycemic excursions in patients with morbid obesity undergone sleeve gastrectomy

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