title: Early changes in incretin secretion after laparoscopic duodenal-jejunal bypass surgery in type 2 diabetic patients.
abstract: 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.
authors.affiliation: Department of Surgery, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hong Chan
authors.initials: HC
authors.lastname: Lee
authors.forename: Mee Kyoung
authors.initials: MK
authors.lastname: Kim
authors.forename: Hyuk Sang
authors.initials: HS
authors.lastname: Kwon
authors.forename: Eungkook
authors.initials: E
authors.lastname: Kim
authors.forename: Ki-Ho
authors.initials: KH
authors.lastname: Song
mesh_terms: 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
chemical_list: D054795:Incretins
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