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 language | English |
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Pages (from-to) | 1354-1360 |
Number of pages | 7 |
Journal | Obesity Surgery |
Volume | 23 |
Issue number | 9 |
DOIs | |
Publication status | Published - Sept 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