Metabolic surgery for non-obese type 2 diabetes: incretins, adipocytokines, and insulin secretion/resistance changes in a 1-year interventional clinical controlled study.
OBJECTIVE
To compare duodenal-jejunal bypass (DJB) with standard medical care in nonobese patients with type 2 diabetes and evaluate surgically induced endocrine and metabolic changes.


METHODS
Eighteen patients submitted to a DJB procedure met the following criteria: overweight, diabetes diagnosis less than 15 years, current insulin treatment, residual β-cell function, and absence of autoimmunity. Patients who refused surgical treatment received standard medical care (control group). At baseline, 3, 6, and 12 months after surgery, insulin sensitivity and production of glucagon-like peptide-1 and glucose-insulinotropic polypeptide were assessed during a meal tolerance test. Fasting adipocytokines and dipeptidyl-peptidase-4 concentrations were measured.


RESULTS
The mean age of the patients was 50 (5) years, time of diagnosis: 9 (2) years, time of insulin usage: 6 (5) months, fasting glucose: 9.9 (2.5) mmol/dL, and HbA1c (glycosylated hemoglobin) level: 8.9% (1.2%). Duodenal-jejunal bypass group showed greater reductions in fasting glucose (22% vs 6% in control group, P < 0.05) and daily insulin requirement (93% vs 15%, P < 0.01). Twelve patients from DJB group stopped using insulin and showed improvements in insulin sensitivity and β-cell function (P < 0.01), and reductions in glucose-insulinotropic polypeptide levels (P < 0.001), glucagon during the first 30 minutes after meal (P < 0.05), and leptin levels (P < 0.05). Dipeptidyl-peptidase-4 levels increased after surgery (P < 0.01), but glucagon-like peptide-1 levels did not change.


CONCLUSIONS
Duodenal-jejunal bypass improved insulin sensitivity and β-cell function and reduced glucose-insulinotropic polypeptide, leptin, and glucagon production. Hence, DJB resulted in better glycemic control and reduction in insulin requirement but DJB did not result in remission of diabetes.
Laboratory of Investigation on Metabolism and Diabetes, University of Campinas- UNICAMP, Rua Camargo Paes 251, Jardim Guanabara, Campinas, São Paulo 13073, Brazil. bgeloneze@terra.com.br
Bruno
B
Geloneze
Sylka Rodovalho
SR
Geloneze
Elinton
E
Chaim
Fernanda Filgueira
FF
Hirsch
Ana Claudia
AC
Felici
Giselle
G
Lambert
Marcos Antonio
MA
Tambascia
José Carlos
JC
Pareja
D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology* / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D018819:Dipeptidyl Peptidase 4 / Q000097:blood; D004386:Duodenum / Q000601:surgery; D005749:Gastric Inhibitory Polypeptide / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D054795:Incretins / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D007583:Jejunum / Q000601:surgery; D008875:Middle Aged
D001786:Blood Glucose; D054795:Incretins; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1; D018819:Dipeptidyl Peptidase 4