Endoscopic duodenal-jejunal bypass liner rapidly improves type 2 diabetes.

C. de Jonge, S.S.M. Rensen, F.J. Verdam, R.P. Vincent, S.R. Bloom, W.A. Buurman, C.W. le Roux, N.C. Schaper, N.D. Bouvy, J.W. Greve

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Bariatric procedures excluding the proximal small intestine improve glycemic control in type 2 diabetes within days. To gain insight into the mediators involved, we investigated factors regulating glucose homeostasis in patients with type 2 diabetes treated with the novel endoscopic duodenal-jejunal bypass liner (DJBL).

Seventeen obese patients (BMI 30-50 kg/m(2)) with type 2 diabetes received the DJBL for 24 weeks. Body weight and type 2 diabetes parameters, including HbA(1c) and plasma levels of glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon, were analyzed after a standard meal before, during, and 1 week after DJBL treatment.

At 24 weeks after implantation, patients had lost 12.7 +/- 1.3 kg (p <0.01), while HbA(1c) had improved from 8.4 +/- 0.2 to 7.0 +/- 0.2 % (p <0.01). Both fasting glucose levels and the postprandial glucose response were decreased at 1 week after implantation and remained decreased at 24 weeks (baseline vs. week 1 vs. week 24: 11.6 +/- 0.5 vs. 9.0 +/- 0.5 vs. 8.6 +/- 0.5 mmol/L and 1,999 +/- 85 vs. 1,536 +/- 51 vs. 1,538 +/- 72 mmol/L/min, both p <0.01). In parallel, the glucagon response decreased (23,762 +/- 4,732 vs. 15,989 +/- 3,193 vs. 13,1207 +/- 1,946 pg/mL/min, p <0.05) and the GLP-1 response increased (4,440 +/- 249 vs. 6,407 +/- 480 vs. 6,008 +/- 429 pmol/L/min, p <0.01). The GIP response was decreased at week 24 (baseline-115,272 +/- 10,971 vs. week 24-88,499 +/- 10,971 pg/mL/min, p <0.05). Insulin levels did not change significantly. Glycemic control was still improved 1 week after explantation.

The data indicate DJBL to be a promising treatment for obesity and type 2 diabetes, causing rapid improvement of glycemic control paralleled by changes in gut hormones.

Original languageEnglish
Pages (from-to)1354-1360
Number of pages7
JournalObesity Surgery
Volume23
Issue number9
DOIs
Publication statusPublished - Sep 2013

Keywords

  • Obesity
  • Type 2 diabetes
  • Gut hormones
  • GLP-1
  • GIP
  • Glucagon
  • BARIATRIC SURGERY
  • GLUCAGON-SECRETION
  • WEIGHT-LOSS
  • GLYCEMIC CONTROL
  • GASTRIC BYPASS
  • INSULIN
  • MELLITUS
  • REMISSION
  • PEPTIDE-1
  • INCRETIN

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