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

Abstract

BACKGROUND:

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).

METHODS:

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 HbA1c 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.

RESULTS:

At 24 weeks after implantation, patients had lost 12.7 ± 1.3 kg (p < 0.01), while HbA1c 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.

CONCLUSIONS:

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.

• Authors: Charlotte de Jonge, Sander S Rensen, Froukje J Verdam, Royce P Vincent, Steve R Bloom, Wim A Buurman, Carel W le Roux, Nicolaas C Schaper, Nicole D Bouvy, Jan Willem M Greve
• Journal: Obesity surgery (Obes Surg) Vol. 23 Issue 9 Pg. 1354-60 (Sep 2013) ISSN: 1708-0428 [Electronic] United States
• PMID: 23526068 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Insulin
• hemoglobin A1c protein, human
• Gastric Inhibitory Polypeptide
• Glucagon-Like Peptide 1
• Glucagon

Topics

• Adolescent
• Adult
• Aged
• Area Under Curve
• Bariatric Surgery (methods)
• Blood Glucose (metabolism)
• Body Mass Index
• Diabetes Mellitus, Type 2 (epidemiology, metabolism, surgery)
• Duodenum (metabolism, surgery)
• Eating
• Endoscopy
• Fasting
• Female
• Gastric Inhibitory Polypeptide
• Glucagon (metabolism)
• Glucagon-Like Peptide 1 (metabolism)
• Glycated Hemoglobin (metabolism)
• Humans
• Insulin (metabolism)
• Insulin Secretion
• Jejunum (metabolism, surgery)
• Male
• Middle Aged
• Netherlands (epidemiology)
• Obesity (epidemiology, metabolism, surgery)
• Pilot Projects
• Postprandial Period
• Remission Induction
• Time Factors
• Treatment Outcome
• Weight Loss