Diabetes remission without weight loss after duodenal bypass surgery

Cohen, Ricardo; Rubino, Francesco; Schiavon, Carlos A.; Cummings, David E.

doi:10.1016/j.soard.2011.07.007

Cited by 40 publications

(22 citation statements)

References 7 publications

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“…However, clinical and experimental data from studies of stomach-sparing procedures, such as duodenal-jejunal bypass (DJB) (3,4,10,(13)(14)(15), endoluminal duodenal sleeve (16,17), ileal-interposition (18,19), jejuno-ileal bypass (20), and jejunectomy (21), show that these approaches can improve type 2 diabetes with relatively minor changes in body weight (22).…”

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confidence: 99%

Duodenal-Jejunal Bypass and Jejunectomy Improve Insulin Sensitivity in Goto-Kakizaki Diabetic Rats Without Changes in Incretins or Insulin Secretion

et al. 2014

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Gastric bypass surgery can dramatically improve type 2 diabetes. It has been hypothesized that by excluding duodenum and jejunum from nutrient transit, this procedure may reduce putative signals from the proximal intestine that negatively influence insulin sensitivity (SI). To test this hypothesis, resection or bypass of different intestinal segments were performed in diabetic Goto-Kakizaki and Wistar rats. Rats were randomly assigned to five groups: duodenal-jejunal bypass (DJB), jejunal resection (jejunectomy), ileal resection (ileectomy), pair-fed sham-operated, and nonoperated controls. Oral glucose tolerance test was performed within 2 weeks after surgery. Baseline and poststimulation levels of glucose, insulin, glucagon-like peptide 1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) were measured. Minimal model analysis was used to assess SI. SI improved after DJB (SI = 1.14 ± 0.32 × 10(-4) min(-1) ⋅ pM(-1)) and jejunectomy (SI = 0.80 ± 0.14 × 10(-4) min(-1) ⋅ pM(-1)), but not after ileectomy or sham operation/pair feeding in diabetic rats. Both DJB and jejunal resection normalized SI in diabetic rats as shown by SI levels equivalent to those of Wistar rats (SI = 1.01 ± 0.06 × 10(-4) min(-1) ⋅ pM(-1); P = NS). Glucose effectiveness did not change after operations in any group. While ileectomy increased plasma GIP levels, no changes in GIP or GLP-1 were observed after DJB and jejunectomy. These findings support the hypothesis that anatomic alterations of the proximal small bowel may reduce factors associated with negative influence on SI, therefore contributing to the control of diabetes after gastric bypass surgery

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confidence: 99%

Duodenal-Jejunal Bypass and Jejunectomy Improve Insulin Sensitivity in Goto-Kakizaki Diabetic Rats Without Changes in Incretins or Insulin Secretion

et al. 2014

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“…However, not all bariatric surgical procedures result in the resolution of type 2 diabetes independent of weight loss. The ability of a surgical procedure to lead to metabolic benefits independent of weight loss suggests that other effects of the surgery contribute to the observed metabolic improvements [7]. …”

Section: ‘Metabolic’ Surgeries Produce Weight Loss-independent Resolumentioning

confidence: 99%

“…In fact, some studies hypothesise that the energy restriction during the peri-operative period may account for the metabolic effects of VSG and RYGB [49, 50]. However, in rodent models, energy restriction alone cannot explain multiple aspects of glucoregulation observed during VSG or RYGB, including changes in gut hormones, hepatic insulin sensitivity and early phase insulin secretion (see later sections and [7]).…”

Section: Rygb and Vsg: Multiple Endpoints Demonstrate Improved Metabomentioning

confidence: 99%

Mechanisms underlying weight loss and metabolic improvements in rodent models of bariatric surgery

2014

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Obesity is a growing health risk with few successful treatment options and fewer still that target both obesity and obesity-associated comorbidities. Despite ongoing scientific efforts, the most effective treatment option to date was not developed from basic research but by surgeons observing outcomes in the clinic. Bariatric surgery is the most successful treatment for significant weight loss, resolution of type 2 diabetes and the prevention of future weight gain. Recent work with animal models has shed considerable light on the molecular underpinnings of the potent effects of these ‘metabolic’ surgical procedures. Here we review data from animal models and how these studies have evolved our understanding of the critical signalling systems that mediate the effects of bariatric surgery. These insights could lead to alternative therapies able to accomplish effects similar to bariatric surgery in a less invasive manner.

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“…The role of the gastric restriction component in reducing food intake and body weight is uncertain. Cohen et al [34] suggested that some form of gastric restriction is necessary to reduce body weight after upper digestive tract surgery, but data on ileal brake activation [35] and ileal transposition surgery [36] suggest otherwise. Furthermore, the stomach remnant after RYGB (15-30 ml) is about the same size as the volume remaining after AGB (15-20 ml).…”

Section: Bariatric Surgery Changes Gut Peptide Secretion To Facilitatmentioning

confidence: 99%

Overeating makes the gut grow fonder; new insights in gastrointestinal satiety signaling in obesity

Maljaars¹

2013

Current Opinion in Gastroenterology

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Diabetes remission without weight loss after duodenal bypass surgery

Cited by 40 publications

References 7 publications

Duodenal-Jejunal Bypass and Jejunectomy Improve Insulin Sensitivity in Goto-Kakizaki Diabetic Rats Without Changes in Incretins or Insulin Secretion

Duodenal-Jejunal Bypass and Jejunectomy Improve Insulin Sensitivity in Goto-Kakizaki Diabetic Rats Without Changes in Incretins or Insulin Secretion

Mechanisms underlying weight loss and metabolic improvements in rodent models of bariatric surgery

Overeating makes the gut grow fonder; new insights in gastrointestinal satiety signaling in obesity

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