Early changes in incretin secretion after laparoscopic duodenal-jejunal bypass surgery in type 2 diabetic patients.
BACKGROUND
A stomach-preserving duodenal-jejunal bypass (DJB) has been used for the treatment of type 2 diabetes mellitus (DM) since Rubino et al. first reported a prospective trial. However, there has been no report on changes in incretin secretion after DJB. We aimed to investigate whether DJB changes incretin secretion in nonmorbidly obese type 2 diabetic patients.


METHODS
The inclusion criteria in this prospective study were: patient age of 20-65 years, body mass index of <30 kg/m(2), a history of type 2 DM for ≤10 years, and fasting C-peptide ≥0.3 nmol/l. Six patients with type 2 DM without morbid obesity underwent DJB. Fasting plasma glucose and glycated hemoglobin (HbA1c) were measured. An oral glucose tolerance test (OGTT) was performed with measurement of glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), insulin, C-peptide, and glucagon. The study subjects were followed up for 6 months.


RESULTS
The body weight of patients declined after surgery. The area under the curve (AUC) of glucose, peak glucose levels during OGTT, and HbA1c also declined until 3 months postoperatively. The AUC of C-peptide and insulin tended to increase postoperatively. The AUC of glucagon had a significant increase at 6 months postoperatively. The AUC of active GLP-1 increased at 1 month and at 6 months postoperatively. There was no change in the AUC of total GIP.


CONCLUSIONS
Our data suggest that DJB increases GLP-1 secretion in nonmorbidly obese type 2 diabetic patients. However, long-term data are needed to confirm this finding.
Lee
Hong Chan
HC
Department of Surgery, The Catholic University of Korea, Seoul, Korea.
Kim
Mee Kyoung
MK
Kwon
Hyuk Sang
HS
Kim
Eungkook
E
Song
Ki-Ho
KH
D000328:Adult; D000714:Anastomosis, Surgical; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism* / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D006801:Humans; D054795:Incretins / Q000096:biosynthesis / Q000378:metabolism*; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged
D054795:Incretins
Nature. 2001 Dec 13;414(6865):782-7
11742409
Obes Surg. 2004 Jun-Jul;14(6):840-8
15318993
Ann Surg. 2002 Nov;236(5):554-9
12409659
Obes Surg. 2005 Apr;15(4):462-73
15946423
Ann Surg. 2006 Nov;244(5):741-9
17060767
Surg Obes Relat Dis. 2007 Mar-Apr;3(2):195-7
17386401
Diabetes Care. 1998 Sep;21(9):1414-31
9727886
Obes Surg. 1998 Feb;8(1):67-72
9562490
Diabetes Metab. 2000 Nov;26(5):363-9
11119015
Am Surg. 2009 Jun;75(6):498-502; discussion 502-3
19545098
J Diabetes Sci Technol. 2008 Jul;2(4):685-91
19885245
Ann Surg. 2004 Jan;239(1):1-11
14685093
Diabetes Care. 2007 Dec;30(12):3145-51
18042754
Diabetes Care. 2005 Oct;28(10):2406-11
16186271
Diabetes Metab. 1996 Apr;22(2):122-31
8792092
Diabetes Care. 2007 Jul;30(7):1709-16
17416796
JAMA. 2004 Oct 13;292(14):1724-37
15479938
Am J Med. 2009 Mar;122(3):248-256.e5
19272486
Diabetologia. 1997 May;40(5):599-605
9165230
Diabetes Metab. 2009 Dec;35(6 Pt 2):518-23
20152737