title: Long segment ileal transposition leads to early amelioration of glucose control in the diabetic obese Zucker rat.
abstract: BACKGROUND
  Fast delivery of food to the terminal ileum is thought to be pathophysiologically responsible for type 2 diabetes remission after obesity surgery. Imitating this effect, ileal transposition (IT) is designed as initiating diabetes remission for non-obese patients.
  
  
  OBJECTIVE
  To date, it is not clear which length of the transposed segment achieves the best glucose lowering results. As previous rodent data mostly rely on a 10 cm IT, the current study evaluated a long segment IT (20 cm) in the diabetic obese Zucker rat.
  
  
  METHODS
  Twenty male diabetic obese Zucker rats (Crl:ZUC-Lepr(fa)) were randomly assigned to undergo either a long segment (20 cm; ∼ 50% of ileum) IT or sham surgery. Glucose control was determined by an oral glucose tolerance test (OGTT) on day -7, 0, 14 and 20. Analysis of the incretin hormones glucagon-like peptide 1 (GLP-1), peptide YY (PYY) and insulin was included in the first and third OGTT.
  
  
  RESULTS
  Ileal transposition animals showed an early improvement of glucose control after 14 days (area under the curve: IT vs. baseline 314.7 ±229.0 mmol/l × min vs. 564.6 ±268.5 mmol/l × min; p < 0.05). Compared to sham animals, glucose-stimulated GLP-1 and PYY levels were raised (5.75 ±3.73 pmol/l vs. 18.52 ±14.22 pmol/l, p < 0.05; 129.7 ±64.62 pmol/l vs. 164.0 ±62.26 pmol/l, p < 0.05). Body weight gain from postoperative day 5 was greater for sham animals (50.22 ±20.93 γ vs. 16.4 ±25.93 g; p < 0.01).
  
  
  CONCLUSIONS
  Long segment IT shows a rapid rise in GLP-1 and PYY levels, thus leading to early amelioration of glucose control.
authors.affiliation: Department of General and Visceral Surgery, Surgical Metabolic and Anastomosis Research Team SMART, Albert-Ludwigs-University, Freiburg, Germany.
authors.forename: Jodok Matthias
authors.initials: JM
authors.lastname: Grueneberger
authors.forename: Tobias
authors.initials: T
authors.lastname: Fritz
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhou
authors.forename: Sebastian
authors.initials: S
authors.lastname: Meyer
authors.forename: Iwona
authors.initials: I
authors.lastname: Karcz-Socha
authors.forename: Tomasz
authors.initials: T
authors.lastname: Sawczyn
authors.forename: Dominica
authors.initials: D
authors.lastname: Stygar
authors.forename: Matthias
authors.initials: M
authors.lastname: Goos
authors.forename: Ulrich Theodor
authors.initials: UT
authors.lastname: Hopt
authors.forename: Simon
authors.initials: S
authors.lastname: Küsters
keywords: ileal transposition; metabolic surgery; obesity surgery; type 2 diabetes mellitus