title: Mid to distal small bowel resection with the preservation of the terminal ileum improves glucose homeostasis in diabetic rats by activating the hindgut-dependent mechanism.
abstract: BACKGROUND
  The aim of this study was to develop a novel surgical model to test the "hindgut hypothesis" and thereby study the role of the gut in glucose homeostasis and the mechanism of action of bariatric surgery.
  
  
  METHODS
  Sprague-Dawley rats were given a high-fat and high-sugar diet and treated with 25 mg/kg streptozotocin (STZ). The fat-sugar-fed/STZ-treated rats were randomized into mid to distal small bowel resection with the preservation of the terminal ileum (DBRPI) and sham operation (which had a formal celiotomy with bowel manipulation only) groups. Rats were observed for 12 weeks after the operation. The main outcome measures were weight, food intake, non-fasting glucose, an oral glucose tolerance test (OGTT), an insulin tolerance test (ITT), the levels of fasting and glucose-induced insulin, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), serum bile acids, and lipid profile.
  
  
  RESULTS
  The DBRPI and sham groups exhibited no difference in weight and food intake after surgery. When compared to the sham controls, the DBRPI group displayed an improvement in non-fasting glucose, oral glucose tolerance, and insulin tolerance at 4 and 12 weeks postresection. DBRPI elicited an increased serum insulin, PYY and GLP-1 levels at 12 weeks postoperation; furthermore, DBRPI resulted in higher serum levels of triglyceride, total bile acids, total bilirubin, and direct bilirubin levels and lower free fatty acid level at 12 weeks.
  
  
  CONCLUSIONS
  This study provides strong evidences for the key role of hindgut in the amelioration of diabetes after bariatric surgery. Moreover, these findings confirm that DBRPI is a simple and effective surgical model for testing the "hindgut hypothesis" and focused study of biliary enterohepatic recycling in the context of bariatric operations.
authors.affiliation: Department of Geriatric Surgery, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, China, jinyuan201314@gmail.com.
authors.forename: Jinyuan
authors.initials: J
authors.lastname: Duan
authors.forename: Jianping
authors.initials: J
authors.lastname: Zhou
authors.forename: Feng
authors.initials: F
authors.lastname: Ren
authors.forename: Cai
authors.initials: C
authors.lastname: Tan
authors.forename: Shaohua
authors.initials: S
authors.lastname: Wang
authors.forename: Lianwen
authors.initials: L
authors.lastname: Yuan
mesh_terms: D000818:Animals; D001647:Bile Acids and Salts / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D001835:Body Weight; D003921:Diabetes Mellitus, Experimental / Q000503:physiopathology*; D004435:Eating; D005230:Fatty Acids, Nonesterified / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D005951:Glucose Tolerance Test; D006706:Homeostasis / Q000502:physiology*; D007082:Ileum / Q000502:physiology* / Q000601:surgery*; D007328:Insulin / Q000097:blood; D007583:Jejunum / Q000601:surgery*; D008111:Liver Function Tests; D023421:Models, Animal; D059351:Organ Sparing Treatments; D019894:Peptide YY / Q000097:blood; D051381:Rats; D017207:Rats, Sprague-Dawley; D014280:Triglycerides / Q000097:blood
chemical_list: D001647:Bile Acids and Salts; D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D014280:Triglycerides; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1; D001663:Bilirubin