Ghrelin suppression is associated with weight loss and insulin action following gastric bypass surgery at 12months in obese adults with type 2 diabetes

Roux-en-Y gastric bypass (RYGB) surgery reverses type 2 diabetes mellitus (T2DM) in approximately 80% of patients. Ghrelin regulates glucose homeostasis, but its role in T2DM remission after RYGB surgery is unclear. Nine obese T2DM subjects underwent a mixed meal tolerance test before and at 1 and 12months after RYGB surgery. Changes in ghrelin, body weight, glucagon-like polypeptide-1 (GLP-1, glucose tolerance and insulin sensitivity (IS) were measured. At 1month, body weight, glycaemia and IS were improved, while ghrelin concentrations were reduced (p<0.05). After 12months, body weight and fasting glucose were reduced (30 and 16%, respectively; p<0.05) and IS was enhanced (threefold; p<0.05). Ghrelin suppression improved by 32% at 12months (p<0.05), and this was associated with weight loss (r=0.72, p=0.03), enhanced IS (r=-0.78, p=0.01) and peak postprandial GLP-1 (r=-0.73, p=0.03). These data suggest that postprandial ghrelin suppression may be part of the mechanism that contributes to diabetes remission after RYGB surgery.