title: Measurement of hepatic insulin sensitivity early after the bypass of the proximal small bowel in humans.
abstract: Unlike gastric banding or sleeve gastrectomy procedures, intestinal bypass procedures, Roux-en-Y gastric bypass in particular, lead to rapid improvements in glycaemia early after surgery. The bypass of the proximal small bowel may have weight loss and even caloric restriction-independent glucose-lowering properties on hepatic insulin sensitivity. In this first human mechanistic study, we examined this hypothesis by investigating the early effects of the duodeno-jejunal bypass liner (DJBL; GI Dynamics, USA) on the hepatic insulin sensitivity by using the gold standard euglycaemic hyperinsulinaemic clamp methodology.
  
  
  
  Seven patients with obesity underwent measurement of hepatic insulin sensitivity at baseline, 1 week after a low-calorie liquid diet and after a further 1 week following insertion of the DJBL whilst on the same diet.
  
  
  
  Duodeno-jejunal bypass liner did not improve the insulin sensitivity of hepatic glucose production beyond the improvements achieved with caloric restriction.
  
  
  
  Caloric restriction may be the predominant driver of early increases in hepatic insulin sensitivity after the endoscopic bypass of the proximal small bowel. The same mechanism may be at play after Roux-en-Y gastric bypass and explain, at least in part, the rapid improvements in glycaemia.
authors.affiliation: Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism Imperial College London London UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Miras
authors.affiliation: CEDAR Centre Royal Surrey County Hospital Guildford Surrey UK.
authors.forename: R
authors.initials: R
authors.lastname: Herring
authors.affiliation: University of Glasgow Glasgow UK.
authors.forename: A
authors.initials: A
authors.lastname: Vusirikala
authors.affiliation: Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences University of Surrey Guildford UK.
authors.forename: F
authors.initials: F
authors.lastname: Shojaee-Moradi
authors.affiliation: Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences University of Surrey Guildford UK.
authors.forename: N C
authors.initials: NC
authors.lastname: Jackson
authors.affiliation: National Obesity Forum UK.
authors.forename: S
authors.initials: S
authors.lastname: Chandaria
authors.affiliation: Diabetes Complications Research Centre, UCD Conway Institute University College Dublin Dublin Ireland.
authors.forename: S N
authors.initials: SN
authors.lastname: Jackson
authors.affiliation: Centre for Neuropsychopharmacology, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London London UK.
authors.forename: A P
authors.initials: AP
authors.lastname: Goldstone
authors.affiliation: Faculty of Medicine, Department of Surgery and Cancer Imperial College London London UK.
authors.forename: N
authors.initials: N
authors.lastname: Hakim
authors.affiliation: Hepatobiliary and minimal access surgery King's College Hospital NHS Foundation Trust London UK.
authors.forename: A G
authors.initials: AG
authors.lastname: Patel
authors.affiliation: Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences University of Surrey Guildford UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Umpleby
authors.affiliation: Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism Imperial College London London UK; Diabetes Complications Research Centre, UCD Conway Institute University College Dublin Dublin Ireland.
authors.forename: C W
authors.initials: CW
authors.lastname: Le Roux
keywords: Caloric restriction; duodeno‐jejunal bypass liner; endobarrier; gastric bypass