title: The impact of EndoBarrier gastrointestinal liner in obese patients with normal glucose tolerance and in patients with type 2 diabetes.
abstract: The duodenal-jejunal bypass sleeve ((DJBS) or EndoBarrier Gastrointestinal Liner) induces weight loss in obese subjects and may improve glucose homeostasis in patients with type 2 diabetes (T2D). To explore the underlying mechanisms, we evaluated postprandial physiology including glucose metabolism, gut hormone secretion, gallbladder emptying, appetite and food intake in patients undergoing DJBS treatment.
  
  
  
  A total of 10 normal glucose-tolerant (NGT) obese subjects and 9 age-, body weight- and body mass index-matched metformin-treated T2D patients underwent a liquid mixed meal test and a subsequent ad libitum meal test before implantation with DJBS and 1 week (1w) and 26 weeks (26w) after implantation.
  
  
  
  At 26w, both groups had achieved a weight loss of 6 to 7 kg. Postprandial glucagon-like peptide-1 (GLP-1) and peptide YY responses increased at 1w and 26w, but only in T2D subjects. In contrast, glucose-dependent insulinotropic polypeptide responses were reduced only by DJBS in the NGT group. Postprandial glucose, insulin, C-peptide, glucagon, cholecystokinin and gastrin responses were unaffected by DJBS in both groups. Satiety and fullness sensations were stronger and food intake was reduced at 1w in NGT subjects; no changes in appetite measures or food intake were observed in the T2D group. No effect of DJBS on postprandial gallbladder emptying was observed, and gastric emptying was not delayed.
  
  
  
  DJBS-induced weight loss was associated with only marginal changes in postprandial physiology, which may explain the absence of effect on postprandial glucose metabolism.
authors.affiliation: Center for Diabetes Research, Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.|Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rohde
authors.affiliation: Center for Diabetes Research, Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
authors.forename: Cecilie A
authors.initials: CA
authors.lastname: Federspiel
authors.affiliation: GastroUnit, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vilmann
authors.affiliation: Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
authors.forename: Ebbe
authors.initials: E
authors.lastname: Langholz
authors.affiliation: Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
authors.forename: Steffen U
authors.initials: SU
authors.lastname: Friis
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Krakauer
authors.affiliation: Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jens F
authors.initials: JF
authors.lastname: Rehfeld
authors.affiliation: Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jens J
authors.initials: JJ
authors.lastname: Holst
authors.affiliation: Center for Diabetes Research, Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Tina
authors.initials: T
authors.lastname: Vilsbøll
authors.affiliation: Center for Diabetes Research, Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.|Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Filip K
authors.initials: FK
authors.lastname: Knop
mesh_terms: D000328:Adult; D001066:Appetite; D050110:Bariatric Surgery / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism*; D001823:Body Composition; D002096:C-Peptide / Q000378:metabolism; D016022:Case-Control Studies; D002766:Cholecystokinin / Q000378:metabolism; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism*; D004435:Eating; D005260:Female; D016473:Gallbladder Emptying; D005746:Gastric Emptying; D005749:Gastric Inhibitory Polypeptide / Q000378:metabolism; D005755:Gastrins / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000601:surgery*; D019894:Peptide YY / Q000378:metabolism; D019518:Postprandial Period; D011446:Prospective Studies; D012528:Satiety Response; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D002766:Cholecystokinin; D005749:Gastric Inhibitory Polypeptide; D005755:Gastrins; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D007328:Insulin; D019894:Peptide YY; C517652:hemoglobin A1c protein, human
keywords: 
  EndoBarrier gastrointestinal liner; gut hormones; obesity; observational study; postprandial glucose homeostasis; type 2 diabetes