title: Jejunum-ileum circuit procedure improves glucose metabolism in diabetic rats independent of weight loss.
abstract: OBJECTIVE
  To introduce a lower-risk novel surgical procedure to achieve diabetes reversal along with associated hormonal changes.
  
  
  METHODS
  Diabetic rats were randomly assigned to jejunum-ileum circuit (JIC), sham-JIC, ileal interposition (IT), and sham-IT groups. The JIC group included two subgroups: short (JIC-S) and long (JIC-L), based on the length between anastomosis and Treitz ligament (LAT ). The body weight, food intake, blood glucose, glucose and insulin tolerance, and gut hormones were measured. The liver gene expression of glucose transporter 2 (GLUT2) and protein expression of glucose-6-phosphatase (G6P) and phosphoenolpyruvate carboxykinase (PKC) were also measured. Following a dye infusion, nutrient delivery was measured at termination day.
  
  
  RESULTS
  Compared to sham-JIC group, JIC-S group did not reduce body weight or food intake but significantly improved glucose tolerance and insulin resistance. With fast chyme transit, JIC-S not only promoted the secretion of insulin, glucagon-like peptide 1, and peptide YY and decreased leptin, but also upregulated hepatic GLUT2 and downregulated hepatic G6P and PKC. JIC-L group, however, failed to achieve remission of diabetes.
  
  
  CONCLUSIONS
  JIC-S relieves diabetes independent of weight loss, as it promotes the secretion of anti-diabetic hormones and inhibits hepatic glucose production. The prolonging of LAT , however, diminishes the hypoglycemic effect.
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu (husanyuan1962@hotmail.com).
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu (husanyuan1962@hotmail.com).
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu (husanyuan1962@hotmail.com).
authors.forename: Teng
authors.initials: T
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu (husanyuan1962@hotmail.com).
authors.forename: Mingwei
authors.initials: M
authors.lastname: Zhong
authors.affiliation: Department of General Surgery, the Fourth Hospital of Jinan, Jinan, Shandong, China.
authors.forename: Houmin
authors.initials: H
authors.lastname: Wan
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu (husanyuan1962@hotmail.com).
authors.forename: Shaozhuang
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu (husanyuan1962@hotmail.com).
authors.forename: Guangyong
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of Bioengineering, California Medical Innovations Institute, San Diego, California, USA.
authors.forename: Ghassan S
authors.initials: GS
authors.lastname: Kassab
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu (husanyuan1962@hotmail.com).
authors.forename: Sanyuan
authors.initials: S
authors.lastname: Hu
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D003921:Diabetes Mellitus, Experimental / Q000378:metabolism / Q000601:surgery*; D005768:Gastrointestinal Hormones / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D005947:Glucose / Q000378:metabolism*; D018149:Glucose Intolerance / Q000378:metabolism; D005952:Glucose-6-Phosphatase / Q000378:metabolism; D007082:Ileum / Q000378:metabolism / Q000601:surgery*; D007583:Jejunum / Q000378:metabolism / Q000601:surgery*; D008297:Male; D019894:Peptide YY / Q000097:blood; D051381:Rats; D017207:Rats, Sprague-Dawley; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D005768:Gastrointestinal Hormones; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1; D005952:Glucose-6-Phosphatase; D005947:Glucose