title: Endoscopic duodenal-jejunal bypass liner rapidly improves type 2 diabetes.
abstract: BACKGROUND
  Bariatric procedures excluding the proximal small intestine improve glycemic control in type 2 diabetes within days. To gain insight into the mediators involved, we investigated factors regulating glucose homeostasis in patients with type 2 diabetes treated with the novel endoscopic duodenal-jejunal bypass liner (DJBL).
  
  
  METHODS
  Seventeen obese patients (BMI 30-50 kg/m(2)) with type 2 diabetes received the DJBL for 24 weeks. Body weight and type 2 diabetes parameters, including HbA1c and plasma levels of glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon, were analyzed after a standard meal before, during, and 1 week after DJBL treatment.
  
  
  RESULTS
  At 24 weeks after implantation, patients had lost 12.7 ± 1.3 kg (p < 0.01), while HbA1c had improved from 8.4 ± 0.2 to 7.0 ± 0.2 % (p < 0.01). Both fasting glucose levels and the postprandial glucose response were decreased at 1 week after implantation and remained decreased at 24 weeks (baseline vs. week 1 vs. week 24: 11.6 ± 0.5 vs. 9.0 ± 0.5 vs. 8.6 ± 0.5 mmol/L and 1,999 ± 85 vs. 1,536 ± 51 vs. 1,538 ± 72 mmol/L/min, both p < 0.01). In parallel, the glucagon response decreased (23,762 ± 4,732 vs. 15,989 ± 3,193 vs. 13,1207 ± 1,946 pg/mL/min, p < 0.05) and the GLP-1 response increased (4,440 ± 249 vs. 6,407 ± 480 vs. 6,008 ± 429 pmol/L/min, p < 0.01). The GIP response was decreased at week 24 (baseline-115,272 ± 10,971 vs. week 24-88,499 ± 10,971 pg/mL/min, p < 0.05). Insulin levels did not change significantly. Glycemic control was still improved 1 week after explantation.
  
  
  CONCLUSIONS
  The data indicate DJBL to be a promising treatment for obesity and type 2 diabetes, causing rapid improvement of glycemic control paralleled by changes in gut hormones.
authors.affiliation: Department of General Surgery and NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: Charlotte
authors.initials: C
authors.lastname: de Jonge
authors.forename: Sander S
authors.initials: SS
authors.lastname: Rensen
authors.forename: Froukje J
authors.initials: FJ
authors.lastname: Verdam
authors.forename: Royce P
authors.initials: RP
authors.lastname: Vincent
authors.forename: Steve R
authors.initials: SR
authors.lastname: Bloom
authors.forename: Wim A
authors.initials: WA
authors.lastname: Buurman
authors.forename: Carel W
authors.initials: CW
authors.lastname: le Roux
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Bouvy
authors.forename: Jan Willem M
authors.initials: JW
authors.lastname: Greve
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D050110:Bariatric Surgery / Q000379:methods; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism / Q000601:surgery*; D004386:Duodenum / Q000378:metabolism / Q000601:surgery*; D004435:Eating; D004724:Endoscopy; D005215:Fasting; D005260:Female; D005749:Gastric Inhibitory Polypeptide; D005934:Glucagon / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D007583:Jejunum / Q000378:metabolism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology / Q000378:metabolism / Q000601:surgery*; D010865:Pilot Projects; D019518:Postprandial Period; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D005749:Gastric Inhibitory Polypeptide; D005934:Glucagon; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human