title: Effect of Duodenal-Jejunal Bypass Surgery on Glycemic Control in Type 2 Diabetes: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To determine whether upper gastrointestinal tract (UGI) bypass itself has beneficial effects on the factors involved in regulating glucose homeostasis in patients with type 2 diabetes (T2D).
  
  
  METHODS
  A 12-month randomized controlled trial was conducted in 17 overweight/obese subjects with T2D, who received standard medical care (SC, n = 7, BMI = 31.7 ± 3.5 kg/m(2) ) or duodenal-jejunal bypass surgery with minimal gastric resection (DJBm) (n = 10; BMI = 29.7 ± 1.9 kg/m(2)). A 5-h modified oral glucose tolerance test was performed at baseline and at 1, 6, and 12 months after surgery or starting SC.
  
  
  RESULTS
  Body weight decreased progressively after DJBm (7.9 ± 4.1%, 9.6 ± 4.2%, and 10.2 ± 4.3% at 1, 6, and 12 months, respectively) but remained stable in the SC group (P < 0.001). DJBm, but not SC, improved: (1) oral glucose tolerance (decreased 2-h glucose concentration, P = 0.039), (2) insulin sensitivity (decreased homeostasis model assessment of insulin resistance, P = 0.013), (3) early insulin response to a glucose load (increased insulinogenic index, P = 0.022), and (4) overall glycemic control (reduction in HbA1c with fewer diabetes medications).
  
  
  CONCLUSIONS
  DJBm causes moderate weight loss and improves metabolic function in T2D. However, our study cannot separate the benefits of moderate weight loss from the potential therapeutic effect of UGI tract bypass itself on the observed metabolic improvements.
authors.affiliation: Center for Obesity and Diabetes, Hospital Oswaldo Cruz, Sao Paulo, Brazil.|Discipline of Endocrinology, Santa Casa Medical School, Sao Paulo, Brazil.
authors.forename: Tarissa Z
authors.initials: TZ
authors.lastname: Petry
authors.affiliation: Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Elisa
authors.initials: E
authors.lastname: Fabbrini
authors.affiliation: Department of Surgery, University Hospital, University of São Paulo, Sao Paulo, Brazil.
authors.forename: Jose P
authors.initials: JP
authors.lastname: Otoch
authors.affiliation: Department of Surgery, University Hospital, University of São Paulo, Sao Paulo, Brazil.
authors.forename: Murilo A
authors.initials: MA
authors.lastname: Carmona
authors.affiliation: Center for Obesity and Diabetes, Hospital Oswaldo Cruz, Sao Paulo, Brazil.
authors.forename: Pedro P
authors.initials: PP
authors.lastname: Caravatto
authors.affiliation: Discipline of Endocrinology, Santa Casa Medical School, Sao Paulo, Brazil.
authors.forename: João E
authors.initials: JE
authors.lastname: Salles
authors.affiliation: Center for Obesity and Diabetes, Hospital Oswaldo Cruz, Sao Paulo, Brazil.
authors.forename: Thais
authors.initials: T
authors.lastname: Sarian
authors.affiliation: Center for Obesity and Diabetes, Hospital Oswaldo Cruz, Sao Paulo, Brazil.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Correa
authors.affiliation: Center for Obesity and Diabetes, Hospital Oswaldo Cruz, Sao Paulo, Brazil.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Schiavon
authors.affiliation: Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Patterson
authors.affiliation: Center for Obesity and Diabetes, Hospital Oswaldo Cruz, Sao Paulo, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Klein
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism / Q000601:surgery*; D015431:Weight Loss / Q000502:physiology
chemical_list: D001786:Blood Glucose