title: Nutrient infusion bypassing duodenum-jejunum improves insulin sensitivity in glucose-tolerant and diabetic obese subjects.
abstract: The mechanisms of type 2 diabetes remission after bariatric surgery is still not fully elucidated. In the present study, we tried to simulate the Roux-en-Y gastric bypass with a canonical or longer biliary limb by infusing a liquid formula diet into different intestinal sections. Nutrients (Nutrison Energy) were infused into mid- or proximal jejunum and duodenum during three successive days in 10 diabetic and 10 normal glucose-tolerant subjects. Plasma glucose, insulin, C-peptide, glucagon, incretins, and nonesterified fatty acids (NEFA) were measured before and up to 360 min following. Glucose rate of appearance (Ra) and insulin sensitivity (SI), secretion rate (ISR), and clearance were assessed by mathematical models. SI increased when nutrients were delivered in mid-jejunum vs. duodenum (SI × 10⁴ min⁻¹·pM⁻¹: 1.11 ± 0.44 vs. 0.62 ± 0.22, P < 0.015, in controls and 0.79 ± 0.34 vs. 0.40 ± 0.20, P < 0.05, in diabetic subjects), whereas glucose Ra was not affected. In controls, Sensitivity of NEFA production was doubled in mid-jejunum vs. duodenum (2.80 ± 1.36 vs. 1.13 ± 0.78 × 10⁶, P < 0.005) and insulin clearance increased in mid-jejunum vs. duodenum (2.05 ± 1.05 vs. 1.09 ± 0.38 l/min, P < 0.03). Bypass of duodenum and proximal jejunum by nutrients enhances insulin sensitivity, inhibits lipolysis, and increases insulin clearance. These results may further our knowledge of the effects of bariatric surgery on both insulin resistance and diabetes.
authors: Department of Computer and System Science, University of Rome La Sapienza, Rome, Italy. salinari@dis.uniroma1.it
authors: Serenella
authors: S
authors: Salinari
authors: Richard D
authors: RD
authors: Carr
authors: Caterina
authors: C
authors: Guidone
authors: Alessandro
authors: A
authors: Bertuzzi
authors: Stefania
authors: S
authors: Cercone
authors: Maria E
authors: ME
authors: Riccioni
authors: Andrea
authors: A
authors: Manto
authors: Giovanni
authors: G
authors: Ghirlanda
authors: Geltrude
authors: G
authors: Mingrone
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000503:physiopathology* / Q000601:surgery; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D004386:Duodenum / Q000378:metabolism*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005502:Food; D018149:Glucose Intolerance / Q000178:diet therapy / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D054795:Incretins / Q000378:metabolism; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology*; D000078790:Insulin Secretion; D050417:Insulin-Secreting Cells / Q000378:metabolism; D007441:Intubation, Gastrointestinal; D007583:Jejunum / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000178:diet therapy / Q000503:physiopathology* / Q000601:surgery
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D054795:Incretins; D007328:Insulin
keywords: bariatric surgery; insulin sensitivity; intestinal glucose infusion