title: Compared to Sleeve Gastrectomy, Duodenal-Jejunal Bypass with Sleeve Gastrectomy Gives Better Glycemic Control in T2DM Patients, with a Lower β-Cell Response and Similar Appetite Sensations: Mixed-Meal Study.
abstract: Functional studies of how duodenal-jejunal exclusion (DJE) brings a superior glycemic control when added to sleeve gastrectomy in duodenal-jejunal bypass with sleeve gastrectomy (DJB-SG) patients, are lacking. To study this, we compared the appetite sensations and the β-cell response following a standard mixed meal in patients with DJB-SG, versus those with sleeve gastrectomy (SG) alone.
  
  
  
  Twenty one patients who underwent DJB-SG and 25 with SG, who participated in mixed-meal tests (MMTT) preoperatively and at 1 year, with complete data were included and compared. Blood glucose, C-peptide, and insulin levels were estimated, along with the visual analogue scale (VAS) scoring of the six appetite sensations, as a part of the MMTT.
  
  
  
  At 1 year following surgery, compared to SG group, DJB-SG group had greater complete remission rates (HbA1C <6.0 %) of 62 versus 32 % (p < 0.05), with similar total body weight loss (25.7 vs. 22 %). There were significantly lower post-prandial blood glucose and lower C-peptide levels during the MMTT in the patients with DJB-SG compared to SG group. There were no significant differences in the appetite sensations (mean VAS) scores between the groups.
  
  
  
  The addition of DJE component to SG, as in DJB-SG, was associated with higher diabetes remission rates, lower glycemic fluctuations, and lower C-peptide levels. This may point to a β-cell preserving glucose control which could result in longer remission of type 2 diabetes mellitus (T2DM). This effect also may be unrelated to food intake as there were no significant differences in the appetite sensations.
authors.affiliation: Department of Surgery and Diabetic Surgery Study Center, Min-Sheng General Hospital, No. 168, Chin-Kuo Road, Touyuan City, Taiwan.|Department of General, Laparoscopic and Bariatric Surgery, Zulekha Hospital Dubai, Dubai, United Arab Emirates.
authors.forename: Pulimuttil James
authors.initials: PJ
authors.lastname: Zachariah
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.|Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Department of Surgery and Diabetic Surgery Study Center, Min-Sheng General Hospital, No. 168, Chin-Kuo Road, Touyuan City, Taiwan. wjlee_obessurg_tw@yahoo.com.tw.
authors.forename: Wei-Jei
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Surgery and Diabetic Surgery Study Center, Min-Sheng General Hospital, No. 168, Chin-Kuo Road, Touyuan City, Taiwan.
authors.forename: Shu-Chu
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Department of Surgery and Diabetic Surgery Study Center, Min-Sheng General Hospital, No. 168, Chin-Kuo Road, Touyuan City, Taiwan.
authors.forename: Kong-Han
authors.initials: KH
authors.lastname: Ser
authors.affiliation: Department of Surgery and Diabetic Surgery Study Center, Min-Sheng General Hospital, No. 168, Chin-Kuo Road, Touyuan City, Taiwan.
authors.forename: Jung-Chien
authors.initials: JC
authors.lastname: Chen
authors.affiliation: Department of International Business, Chien Hsin University of Science and Technology, Taoyuan City, Taiwan.
authors.forename: Yi-Chih
authors.initials: YC
authors.lastname: Lee
mesh_terms: D000328:Adult; D001066:Appetite / Q000502:physiology*; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism; D000078790:Insulin Secretion; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D007583:Jejunum / Q000601:surgery; D008297:Male; D062407:Meals; D008875:Middle Aged; D019518:Postprandial Period; D012074:Remission Induction; D012189:Retrospective Studies; D012528:Satiety Response / Q000502:physiology; D012677:Sensation; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Duodenal–jejunal bypass; Metabolic surgery; Mixed-meal tolerance test; Sleeve gastrectomy; β-cell response