Evidence map›Paper›PMID 33870426›Full record

Trial reportThe Journal of clinical endocrinology and metabolism2021

Foregut Exclusion Enhances Incretin and Insulin Secretion After Roux-en-Y Gastric Bypass in Adults With Type 2 Diabetes.

John P Kirwan, Christopher L Axelrod, Emily L Kullman, Steven K Malin, Wagner S Dantas, Kathryn Pergola, Juan Pablo Del Rincon, Stacy A Brethauer, Sangeeta R Kashyap, Philip R Schauer

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The Journal of clinical endocrinology and metabolism, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.3field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 13 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

John P KirwanDepartment of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH,USA.
Christopher L AxelrodDepartment of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH,USA.ORCID 0000-0002-1444-8557
Emily L KullmanDepartment of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH,USA.
Steven K MalinDepartment of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH,USA.
Wagner S DantasIntegrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA,USA.
Kathryn PergolaIntegrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA,USA.
Juan Pablo Del RinconDepartment of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH,USA.
Stacy A BrethauerBariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio,USA.
Sangeeta R KashyapDepartment of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio,USA.
Philip R SchauerBariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio,USA.
Pennington Biomedical Research Center · USCleveland Clinic Lerner College of Medicine · USCleveland Clinic · US

Funding

NCATS NIH HHS UL1 TR002548NCRR NIH HHS 1UL1RR024989NCRR NIH HHS UL1 RR024989NIDDK NIH HHS R01 DK089547NIH HHS DK089547
6 · The paper itself

Abstract

introductionPatients with type 2 diabetes experience resolution of hyperglycemia within days after Roux-en-Y gastric bypass (RYGB) surgery. This is attributed, in part, to enhanced secretion of hindgut factors following exclusion of the gastric remnant and proximal intestine during surgery. However, evidence of the mechanisms of remission remain limited due to the challenges of metabolic evaluation during the early postoperative period. The purpose of this investigation was to determine the role of foregut exclusion in the resolution of type 2 diabetes after RYGB.

methodsPatients with type 2 diabetes (n = 15) undergoing RYGB had a gastrostomy tube (G-tube) placed in their gastric remnant at time of surgery. Patients were randomized to receive a mixed meal tolerance test via oral or G-tube feeding immediately prior to and 2 weeks after surgery in a repeated measures crossover design. Plasma glucose, insulin, C-peptide, incretin responses, and indices of meal-stimulated insulin secretion and sensitivity were determined.

resultsBody weight, fat mass, fasting glucose and insulin, and circulating lipids were significantly decreased 2 weeks after surgery. The glycemic response to feeding was reduced as a function of total area under the curve but not after adjustment for the reduction in fasting glucose. Oral feeding significantly enhanced insulin and incretin secretion after RYGB, which was entirely ablated by G-tube feeding.

conclusionForegut exclusion accounts for the rise in incretin and insulin secretion but may not fully explain the early improvements in glucose metabolism after RYGB surgery.

Indexed as

Enteral NutritionGastric BypassAdolescentAdultArea Under CurveBlood GlucoseBody CompositionCross-Over StudiesDiabetes Mellitus, Type 2Feeding MethodsFemaleGastric StumpGlycemic ControlHumansIncretinsInsulin SecretionBlood GlucoseIncretinsbariatric surgeryincretin secretioninsulin secretionobesityroux-en-Y gastric bypasstype 2 diabetes

Identifiers

PMID33870426
PMCPMC8475221
OpenAlexW3152964147

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.