title: Moderate effect of duodenal-jejunal bypass surgery on glucose homeostasis in patients with type 2 diabetes.
abstract: Gastric bypass surgery causes resolution of type 2 diabetes (T2DM), which has led to the hypothesis that upper gastrointestinal (UGI) tract diversion, itself, improves glycemic control. The purpose of this study was to determine whether UGI tract bypass without gastric exclusion has therapeutic effects in patients with T2DM. We performed a prospective trial to assess glucose and β-cell response to an oral glucose load before and at 6, 9, and 12 months after duodenal-jejunal bypass (DJB) surgery. Thirty-five overweight or obese adults (BMI: 27.0 ± 4.0 kg/m(2)) with T2DM and 35 sex-, age-, race-, and BMI-matched subjects with normal glucose tolerance (NGT) were studied. Subjects lost weight after surgery, which was greatest at 3 months (6.9 ± 4.9%) with subsequent regain to 4.2 ± 5.3% weight loss at 12 months after surgery. Glycated hemoglobin (HbA(1c)) decreased from 9.3 ± 1.6% before to 7.7 ± 2.0% at 12 months after surgery (P < 0.001), in conjunction with a 20% decrease in the use of diabetes medications (P < 0.05); 7 (20%) subjects achieved remission of diabetes (no medications and HbA(1c) <6.5%). The area under the curve after glucose ingestion was ~20% lower for glucose but doubled for insulin and C-peptide at 12 months, compared with pre-surgery values (all P < 0.01). However, the β-cell response was still 70% lower than subjects with NGT (P < 0.001). DJB surgery improves glycemic control and increases, but does not normalize the β-cell response to glucose ingestion. These findings suggest that altering the intestinal site of delivery of ingested nutrients has moderate therapeutic effects by improving β-cell function and glycemic control.
authors.affiliation: Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA. sklein@dom.wustl.edu
authors.forename: Samuel
authors.initials: S
authors.lastname: Klein
authors.forename: Elisa
authors.initials: E
authors.lastname: Fabbrini
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Patterson
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Polonsky
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Schiavon
authors.forename: Jose L
authors.initials: JL
authors.lastname: Correa
authors.forename: Joao E
authors.initials: JE
authors.lastname: Salles
authors.forename: Bernardo L
authors.initials: BL
authors.lastname: Wajchenberg
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000601:surgery; D004386:Duodenum / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood* / Q000601:surgery; D012074:Remission Induction; D015431:Weight Loss; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human