CHANGE OF GHRELIN CONCENTRATION IN TYPE 2 DIABETES MELLITUS ASSOCIATED WITH OBESITY IN THE EARLY AND DELAYED PERIOD AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY

Abstract

Laparoscopic sleeve gastrectomy (LSG) is an effective method of treating obesity complicated by type 2 diabetes mellitus (T2DM). The performance of this metabolic surgical intervention involves removal fundus of the stomach, which in turn leads to an effect on the eating behavior of patients in the form of a decrease in appetite and loss of excess body weight with a parallel effect on the compensation of T2DM in the postoperative period, regardless of the loss of body weight. At present, mechanisms of T2DM compensation after LSG have not yet been clearly defined. The aim of our study was to study the effect of LSG on the dynamics of changes in the blood plasma ghrelin levels in patients with T2DM associated with obesity. The plasma ghrelin levels were assessed in the fasted state, 15, 30, 60, and 90 min after a standard breakfast carbohydrate preload, which included 125 ml of Nutricia Nutridrink, a balanced high-energy protein. The examination was carried out before the operation, on the 4th postoperative day and 3 months after the operation. 7 patients were diagnosed with T2DM for the first time, 3 had a history of diabetes for 2 years, one patient had a history of 3.5 years, and another had a history of 10 years. The average content of glycated hemoglobin before the operation was 7.7%, 3 months after LSG - 5.9%. The fasting ghrelin concentration before LSG performing was 6.8 ng/ml, on the 4th postoperative day – 4.6 ng/ml, and 3 months after the operation – 4.4 ng/ml (P = 0.001) in comparison with preoperative indicators). The peak insulin concentration was noted 30 min after the carbohydrate preload 3 months after the operation and was 175.1 μU/ml, and its fasting levels in the postoperative period reached a statistically significant difference compared to the preoperative values (30 μU/ml before surgery and 25.3 μU/ml 3 months after LSG). Thus, LSG leads to an early and significant suppression of fasting ghrelin secretion in patients with obesity-associated T2DM and likely to restore insulin secretion and/or reduce insulin resistance. Rapid postoperative improvement of carbohydrate metabolism components indicates the importance of the early reduction of ghrelin secretion in combination with the incretin effect of LSG in the implementation of the mechanisms of early compensation of T2DM and explains the metabolic activity of this operation and the significant role of the stomach in the regulation of glucose metabolism.