Obesity Surgery

, Volume 28, Issue 10, pp 3165–3171 | Cite as

Increased Serum IGFBP-1 and Reduced Insulin Resistance After Roux-En-Y Gastric Bypass in Chinese Patients with Type 2 Diabetes: a 6-Month Follow-Up

  • Zhigao Song
  • Xiaojian Dai
  • Hao Yu
  • Qing Luo
  • Hongbin ZhangEmail author
  • Liangping WuEmail author
Original Contributions



This study aimed to measure changes of insulin-like growth factor binding protein-1 (IGFBP-1) in patients with type 2 diabetes mellitus (T2D) following gastric bypass surgery.


A total of 10 patients with T2D underwent laparoscopic Roux-en-Y gastric bypass (RYGB) surgery. Patient height, weight, waist circumference, and hip circumference were measured pre- and post-operatively at 6 months after surgery. Serum samples were collected at 6 months after surgery to determine fasting blood glucose, glycosylated Hb, fasting insulin, C-peptide, and 2-h postprandial blood glucose, insulin, and C-peptide. Serum was collected at 3 days and 6 months after surgery and IGFBP-1 level determined using ELISA. Serum samples were also collected from 30 healthy weight subjects and 27 overweight control subjects.


Body weight, BMI, and waist circumference were significantly improved following RYGB surgery. Blood glucose, fasting blood glucose, 2-h postprandial blood glucose, and HbA1c were also significantly improved. Fasting C-peptide and 2-h postprandial C-peptide were non-significantly reduced. Serum IGFBP-1 significantly increased at 3 days and 6 months after RYGB surgery. Pre-operative serum IGFBP-1 was not significantly different from healthy weight subjects or overweight subjects.


Increased serum level of IGF-binding proteins after RYGB in 6 months is increased post-surgery compared with overweight and healthy weight controls. IGFBP-1 may serve as part of new supplementary criteria for surgical selection and for defining the success of RYGB.


RYGB IGFBP-1 Insulin sensitivity T2D 


Compliance with Ethical Standards

Approval for this study was granted by the Ethics Committee of General Hospital of Guangzhou Military Command. This study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all patients involved in the study (or from their parents or guardians if they were aged less than 18 years). Patient data were kept anonymous to ensure confidentiality and privacy.

Conflict of Interest

Zhigao Song, Xiaojian Dai, Hao Yu, Hongbing Zhang, Qing Luo, Hongbin Zhang, Wu Liangping declare that they have no conflicts of interest.

This work was supported by Science and Technology Planning Project of Guangzhou, China (No. 201508020002), Science and Technology Planning Project of Guangzhou (No. 201604020106).

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human Rights

The study was approved by the Ethics Committee of General Hospital of Guangzhou Military Command and complied with the Declaration of Helsinki.


  1. 1.
    Unnikrishnan R, Pradeepa R, Joshi SR, et al. Type 2 diabetes: demystifying the global epidemic. Diabetes. 2017;66:1432–42.CrossRefPubMedGoogle Scholar
  2. 2.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–350–50-352.CrossRefGoogle Scholar
  3. 3.
    Hjortebjerg R, Laugesen E, Hoyem P, et al. The IGF system in patients with type 2 diabetes: associations with markers of cardiovascular target organ damage. Eur J Endocrinol. 2017;176:521–31.CrossRefPubMedGoogle Scholar
  4. 4.
    Rajpathak SN, Gunter MJ, Wylie-Rosett J, et al. The role of insulin-like growth factor-I and its binding proteins in glucose homeostasis and type 2 diabetes. Diabetes Metab Res Rev. 2009;25:3–12.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Frystyk J, Skjaerbaek C, Vestbo E, et al. Circulating levels of free insulin-like growth factors in obese subjects: the impact of type 2 diabetes. Diabetes Metab Res Rev. 1999;15:314–22.CrossRefPubMedGoogle Scholar
  6. 6.
    Payne JF, Tangpricha V, Cleveland J, et al. Serum insulin-like growth factor-I in diabetic retinopathy. Mol Vis. 2011;17:2318–24.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Urakami T, Kubota S, Nitadori Y, et al. Annual incidence and clinical characteristics of type 2 diabetes in children as detected by urine glucose screening in the Tokyo metropolitan area. Diabetes Care. 2005;28:1876–81.CrossRefPubMedGoogle Scholar
  8. 8.
    Song X, Teng J, Wang A, et al. Positive correlation between serum IGF-1 and HDL-C in type 2 diabetes mellitus. Diabetes Res Clin Pract. 2016;118:44–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Rajpathak SN, He M, Sun Q, et al. Insulin-like growth factor axis and risk of type 2 diabetes in women. Diabetes. 2012;61:2248–54.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Brynskov T, Laugesen CS, Floyd AK, et al. The IGF-Axis and diabetic retinopathy before and after gastric bypass surgery. Obes Surg. 2017;27:408–15.CrossRefPubMedGoogle Scholar
  11. 11.
    Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377:1143–55.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Smeu B, Balescu I, Sarbu A, et al. Early improvement in glycemic metabolism after laparoscopic sleeve gastrectomy in obese patients - a prospective study. Chirurgia (Bucur). 2015;110:430–9.Google Scholar
  13. 13.
    Raverdy V, Baud G, Pigeyre M, et al. Incidence and predictive factors of postprandial Hyperinsulinemic hypoglycemia after roux-en-Y gastric bypass: a five year longitudinal study. Ann Surg. 2016;264:878–85.CrossRefPubMedGoogle Scholar
  14. 14.
    Moses AC, Young SC, Morrow LA, et al. Recombinant human insulin-like growth factor I increases insulin sensitivity and improves glycemic control in type II diabetes. Diabetes. 1996;45:91–100.CrossRefPubMedGoogle Scholar
  15. 15.
    Haywood NJ, Cordell PA, Tang KY, et al. Insulin-like growth factor binding protein 1 could improve glucose regulation and insulin sensitivity through its RGD domain. Diabetes. 2017;66:287–99.CrossRefPubMedGoogle Scholar
  16. 16.
    Lang CH, Vary TC, Frost RA. Acute in vivo elevation of insulin-like growth factor (IGF) binding protein-1 decreases plasma free IGF-I and muscle protein synthesis. Endocrinology. 2003;144:3922–33.CrossRefPubMedGoogle Scholar
  17. 17.
    Laager R, Keller U. Effects of recombinant human insulin-like growth factor I and insulin on counterregulation during acute plasma glucose decrements in normal and type 2 (non-insulin-dependent) diabetic subjects. Diabetologia. 1993;36:966–71.CrossRefPubMedGoogle Scholar
  18. 18.
    Lee PD, Lustig RH, Lenders C, et al. Insulin-like growth factor binding protein 1 predicts insulin sensitivity and insulin area-under-the-curve in obese, nondiabetic adolescents. Endocr Pract. 2016;22:136–42.CrossRefPubMedGoogle Scholar
  19. 19.
    Aneke-Nash CS, Parrinello CM, Rajpathak SN, et al. Changes in insulin-like growth factor-I and its binding proteins are associated with diabetes mellitus in older adults. J Am Geriatr Soc. 2015;63:902–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Gokulakrishnan K, Velmurugan K, Ganesan S, et al. Circulating levels of insulin-like growth factor binding protein-1 in relation to insulin resistance, type 2 diabetes mellitus, and metabolic syndrome (Chennai urban rural epidemiology study 118). Metabolism. 2012;61:43–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Hjortebjerg R, Flyvbjerg A, Frystyk J. Insulin growth factor binding proteins as therapeutic targets in type 2 diabetes. Expert Opin Ther Targets. 2014;18:209–24.CrossRefPubMedGoogle Scholar
  22. 22.
    Matsui H, Musicki B, Sopko NA, et al. Early-stage type 2 diabetes mellitus impairs erectile function and neurite outgrowth from the major pelvic ganglion and downregulates the gene expression of neurotrophic factors. Urology. 2017;99:281–7.CrossRefGoogle Scholar
  23. 23.
    Luo J, Murphy LJ. Differential expression of the insulin-like growth factor binding proteins in spontaneously diabetic rats. J Mol Endocrinol. 1992;8:155–63.CrossRefPubMedGoogle Scholar
  24. 24.
    Katz LE, DeLeon DD, Zhao H, et al. Free and total insulin-like growth factor (IGF)-I levels decline during fasting: relationships with insulin and IGF-binding protein-1. J Clin Endocrinol Metab. 2002;87:2978–83.CrossRefPubMedGoogle Scholar
  25. 25.
    Matsumoto T, Ishida K, Nakayama N, et al. Involvement of NO and MEK/ERK pathway in enhancement of endothelin-1-induced mesenteric artery contraction in later-stage type 2 diabetic Goto-Kakizaki rat. Am J Physiol Heart Circ Physiol. 2009;296:H1388–97.CrossRefPubMedGoogle Scholar
  26. 26.
    Farey JE, Fisher OM, Levert-Mignon AJ, et al. Decreased levels of circulating Cancer-associated protein biomarkers following bariatric surgery. Obes Surg. 2017;27:578–85.CrossRefPubMedGoogle Scholar
  27. 27.
    Mohan S, Baylink DJ. IGF-binding proteins are multifunctional and act via IGF-dependent and -independent mechanisms. J Endocrinol. 2002;175:19–31.CrossRefPubMedGoogle Scholar
  28. 28.
    Sabater M, Moreno-Navarrete JM, Ortega FJ, et al. Circulating pigment epithelium-derived factor levels are associated with insulin resistance and decrease after weight loss. J Clin Endocrinol Metab. 2010;95:4720–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Moreno-Navarrete JM, Ortega F, Serino M, et al. Circulating lipopolysaccharide-binding protein (LBP) as a marker of obesity-related insulin resistance. Int J Obes. 2012;36:1442–9.CrossRefGoogle Scholar
  30. 30.
    Kim KE, Cho YS, Baek KS, et al. Lipopolysaccharide-binding protein plasma levels as a biomarker of obesity-related insulin resistance in adolescents. Korean J Pediatr. 2016;59:231–8.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Fruhbeck G, Gomez-Ambrosi J. Rationale for the existence of additional adipostatic hormones. FASEB J. 2001;15:1996–2006.CrossRefPubMedGoogle Scholar
  32. 32.
    Tschop M, Smiley DL, Heiman ML. Ghrelin induces adiposity in rodents. Nature. 2000;407:908–13.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Liver GC. Asprosin - new hormone involved in hepatic glucose release. Nat Rev Endocrinol. 2016;12:312.Google Scholar
  34. 34.
    Fruhbeck G. Bariatric and metabolic surgery: a shift in eligibility and success criteria. Nat Rev Endocrinol. 2015;11:465–77.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Metabolic Surgery, General Hospital of Guangzhou Military CommandSouthern Medical UniversityGuangzhouChina
  2. 2.UDM Medical GroupGuangzhouChina

Personalised recommendations