title: The effect of duodenojejunostomy and sleeve gastrectomy on type 2 diabetes mellitus and gastrin secretion in Goto-Kakizaki rats.
abstract: BACKGROUND
  Bariatric surgery is a highly effective treatment of type 2 diabetes in patients with morbid obesity. The weight-loss independent improvement of glycemic control observed after these procedures has led to the discussion whether bariatric surgery can be introduced as treatment for type 2 diabetes in patients with a body mass index < 35 kg/m(2). We have studied the effects of two bariatric procedures on type 2 diabetes and on gastrointestinal hormone secretion in a lean diabetic animal model.
  
  
  METHODS
  Male Goto-Kakizaki rats, 17-18 weeks old, were randomized into three groups: duodenojejunostomy (DJ), sleeve gastrectomy (SG), or sham operation. During 36 postoperative weeks we evaluated body weight, fasting blood glucose, glucose tolerance, insulin, HbA1c, glucagon-like peptide 1, cholesterol parameters, triglycerides, total ghrelin, and gastrin.
  
  
  RESULTS
  Oral glucose tolerance was significantly improved for both DJ and SG at four weeks after surgery (p < 0.05). At the 34th postoperative week, SG had significantly lower area under the curve during oral glucose tolerance test compared to sham (p = 0.007). SG had significantly lower HbA1c compared to sham at 12 weeks; (mean ± SEM) 4.3 ± 0.1 % versus 5.2 ± 0.3 % (p < 0.05) and compared to both DJ and sham 34 weeks after surgery [median (75 %;25 %)] 5.2 (6.0; 4.3) % versus 7.0 (7.5; 6.7) % and 7.3 (7.6; 6.7) % (p = 0.009). Serum gastrin levels were markedly elevated for SG compared to DJ and sham; 188.0 (318.0; 121.0) versus 77.5 (114.0; 58.0) and 68.0 (90.0; 59.5) pmol/L (p = 0.004) at six weeks and 192.0 (587.8; 110.8) versus 65.5 (77.0; 59.0) and 69.5 (113.0; 55.5) (p = 0.001) 36 weeks after surgery.
  
  
  CONCLUSIONS
  Sleeve gastrectomy induces hypergastrinemia, lowers HbA1c, and improves glycemic control in Goto-Kakizaki rats. Sleeve gastrectomy is superior to duodenojejunostomy as treatment of type 2 diabetes mellitus in this animal model.
authors.affiliation: Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), PB 8905, 7491, Trondheim, Norway, eivig@stud.ntnu.no.
authors.forename: Eivind
authors.initials: E
authors.lastname: Grong
authors.forename: Ingerid Brænne
authors.initials: IB
authors.lastname: Arbo
authors.forename: Ole Kristian Forstrønen
authors.initials: OK
authors.lastname: Thu
authors.forename: Esther
authors.initials: E
authors.lastname: Kuhry
authors.forename: Bård
authors.initials: B
authors.lastname: Kulseng
authors.forename: Ronald
authors.initials: R
authors.lastname: Mårvik
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003921:Diabetes Mellitus, Experimental; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism; D004385:Duodenostomy / Q000379:methods*; D005743:Gastrectomy / Q000379:methods*; D005755:Gastrins / Q000378:metabolism*; D015391:Gastroplasty / Q000379:methods*; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D051381:Rats
chemical_list: D001786:Blood Glucose; D005755:Gastrins
references.citation: J Clin Endocrinol Metab. 2012 Nov;97(11):E2105-8
references.pmid: 22904177
references.citation: Obes Surg. 2010 Dec;20(12):1720-6
references.pmid: 20798995
references.citation: J Pharmacokinet Pharmacodyn. 2011 Feb;38(1):143-62
references.pmid: 21127951
references.citation: Obes Surg. 2013 Dec;23(12):2013-7
references.pmid: 23912263
references.citation: J Gastrointest Surg. 2009 Dec;13(12):2302-8
references.pmid: 19727970
references.citation: Diabetes Care. 2013 Jan;36(1):20-6
references.pmid: 23033249
references.citation: Endocrinology. 2011 Jul;152(7):2580-8
references.pmid: 21558313
references.citation: Metabolism. 2000 Mar;49(3):347-52
references.pmid: 10726913
references.citation: Diabetes Care. 2012 Jul;35(7):1399-400
references.pmid: 22723576
references.citation: N Engl J Med. 2012 Apr 26;366(17):1577-85
references.pmid: 22449317
references.citation: Scand J Gastroenterol. 1985 Jun;20(5):569-76
references.pmid: 2992067
references.citation: J Clin Invest. 1973 Jun;52(6):1415-26
references.pmid: 4703228
references.citation: Diabetologia. 2010 Oct;53(10):2220-3
references.pmid: 20585936
references.citation: Obes Surg. 2009 Aug;19(8):1077-83
references.pmid: 19475464
references.citation: Obes Surg. 2011 Feb;21(2):231-7
references.pmid: 21086062
references.citation: Diabetologia. 1975 Feb;11(1):89-92
references.pmid: 1140520
references.citation: Surg Obes Relat Dis. 2009 Mar-Apr;5(2):212-7
references.pmid: 19136315
references.citation: Obesity (Silver Spring). 2012 Jun;20(6):1266-72
references.pmid: 22262157
references.citation: Surg Endosc. 2014 Mar;28(3):1010-8
references.pmid: 24190081
references.citation: Ann Surg. 2004 Jan;239(1):1-11
references.pmid: 14685093
references.citation: Ann Surg. 2004 Aug;240(2):236-42
references.pmid: 15273546
references.citation: J Endocrinol Invest. 2014 May;37(5):449-54
references.pmid: 24682913
references.citation: Ann Surg. 2008 Jun;247(6):968-75
references.pmid: 18520224
references.citation: Am J Physiol Endocrinol Metab. 2011 May;300(5):E923-32
references.pmid: 21304061
references.citation: Med Hypotheses. 2009 Jul;73(1):29-32
references.pmid: 19304401
references.citation: Diabetes Care. 2008 Feb;31 Suppl 2:S290-6
references.pmid: 18227499
references.citation: Diabetes Care. 2013 Aug;36(8):2175-82
references.pmid: 23439632
references.citation: J Clin Endocrinol Metab. 2012 Nov;97(11):3915-6
references.pmid: 23129595
references.citation: Diabetes Res Clin Pract. 2010 Dec;90(3):e72-4
references.pmid: 20888658
references.citation: Surg Endosc. 2011 Nov;25(11):3540-50
references.pmid: 21638183
references.citation: Clin Chem. 1972 Jun;18(6):499-502
references.pmid: 4337382
references.citation: Surg Gynecol Obstet. 1993 Jan;176(1):65-72
references.pmid: 8093984
references.citation: Obes Surg. 2007 Dec;17(12):1614-8
references.pmid: 18040751
references.citation: Obes Surg. 2007 Jan;17(1):138-9
references.pmid: 17355780
references.citation: Am J Med. 2009 Mar;122(3):248-256.e5
references.pmid: 19272486
references.citation: Diabetes Care. 2013 Aug;36 Suppl 2:S287-91
references.pmid: 23882061
references.citation: Annu Rev Med. 2010;61:393-411
references.pmid: 20059345
references.citation: Diabetes Metab. 2009 Dec;35(6 Pt 2):518-23
references.pmid: 20152737
references.citation: Diabetes Care. 1992 Jul;15(7):815-9
references.pmid: 1516497
references.citation: Diabetes Obes Metab. 2013 Jan;15(1):62-71
references.pmid: 22862961
references.citation: Diabetes Res Clin Pract. 2010 Jan;87(1):4-14
references.pmid: 19896746
references.citation: Physiol Genomics. 2005 Jun 16;22(1):24-32
references.pmid: 15827235
references.citation: Obes Surg. 2010 Sep;20(9):1245-50
references.pmid: 20524158
references.citation: J Pharmacol Exp Ther. 2011 Dec;339(3):896-904
references.pmid: 21903749
references.citation: N Engl J Med. 2012 Apr 26;366(17):1567-76
references.pmid: 22449319
references.citation: Diabetologia. 2003 Jan;46(1):3-19
references.pmid: 12637977
references.citation: Diabetologia. 2013 Jan;56(1):22-30
references.pmid: 23011351
references.citation: Aliment Pharmacol Ther. 1999 Feb;13(2):145-53
references.pmid: 10102943
references.citation: Am J Clin Nutr. 1992 Feb;55(2 Suppl):615S-619S
references.pmid: 1733140
references.citation: Diabetologia. 1985 Jul;28(7):412-9
references.pmid: 3899825
references.citation: Diabetes. 2008 Dec;57(12):3281-8
references.pmid: 18835930
references.citation: J Pharmacol Exp Ther. 2012 Jun;341(3):617-25
references.pmid: 22378938
references.citation: Am J Pathol. 2011 Jun;178(6):2632-40
references.pmid: 21641386