Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22–34 kg/m2: a report of 2 cases

Cohen, Ricardo; Schiavon, Carlos A.; Pinheiro, Joana; Correa, Jose L.; Rubino, Francesco

doi:10.1016/j.soard.2007.01.009

Cited by 195 publications

(122 citation statements)

References 11 publications

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“…Surgical control of diabetes may thus be potentially obtained also in patients who do not meet current criteria for bariatric surgery (BMI >40 kg/m 2 or BMI >35 kg/m 2 with high-risk comorbid conditions). Recent reports corroborate this hypothesis showing that a variety of operations, including Roux-en-Y gastric bypass [3], duodenal-jejunal bypass [4] and gastric banding [5] can dramatically improve diabetes in patients with BMI <35 kg/m 2 . The physiological basis of the improvement in diabetes after surgery is still unclear; however, the dominant hypotheses involve changes in hormone signalling from the small bowel, which may influence insulin sensitivity, insulin secretion, or both.…”

Section: Introductionmentioning

confidence: 77%

“…Only a few studies have reported on the efficacy of gastrointestinal surgery in non-obese diabetes patients using standard Roux-en-Y gastric bypass [3], gastric banding [4] or novel procedures such as duodenal-jejunal bypass [5]. This is the first prospective case series study showing that BPD can achieve rapid, complete and stable remission of type 2 diabetes in patients with BMIs between 27 and 33 kg/m 2 .…”

Section: Discussionmentioning

confidence: 95%

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The effect of bilio-pancreatic diversion on type 2 diabetes in patients with BMI <35 kg/m2

et al. 2009

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Aims/hypothesis To aim of the study was to investigate the effect of bilio-pancreatic diversion (BPD) on type 2 diabetes in patients with BMI <35 kg/m 2 . Methods OGTTs were performed and anthropometric data were compared between five diabetes patients (BMI 27-33 kg/m 2 ) following BPD and seven diabetes patients after a low-energy diet. Insulin secretion was computed by C-peptide deconvolution. A euglycaemic-hyperinsulinaemic clamp was performed only in the BPD group and the M value measured. Results One month after BPD, fasting and 2 h post-OGTT glycaemia decreased from 15.22±3.22 to 6.22± 0.51 mmol/l (p=0.043), while insulin sensitivity increased significantly. No significant changes were observed in the low-energy diet group. Insulin secretion did not differ significantly after either intervention. Diabetes amelioration (change in HbA 1c level) was observed up to 18 months after BPD without pharmacological therapy. Conclusions/interpretation BPD can achieve adequate control of type 2 diabetes also in patients with BMI <35 kg/m 2 . The rapid postoperative remission of diabetes is primarily related to an improvement in insulin sensitivity.

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Section: Introductionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 95%

The effect of bilio-pancreatic diversion on type 2 diabetes in patients with BMI <35 kg/m2

et al. 2009

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“…Similar observations have subsequently been made with independent investigations of non-obese diabetic Goto-Kakizaki rats 20,21 and obese diabetic Zucker rats. 18 Likewise, several small, ongoing human studies of DJB all show improvements in glycemic control, including among non-obese patients, with little or no weight loss (Cohen et al 46 and personal communications with Arguelles-Sarmiento J et al, Lakdawala M et al, and Ramos AC et al).…”

Section: The Upper Intestinal Hypothesismentioning

confidence: 99%

“…13,19,[46][47][48] Thus, although these interventions seem only to re-route the flow of food through the GI tract after meals, they exert salutary effects on glycemia that persist between meals.…”

Section: The Upper Intestinal Hypothesismentioning

confidence: 99%

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

2009

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Bariatric surgery is currently the most effective method to promote major, sustained weight loss. Roux-en-Y gastric bypass (RYGB), the most commonly performed bariatric operation, ameliorates virtually all obesity-related comorbid conditions, the most impressive being a dramatic resolution of type 2 diabetes mellitus (T2DM). After RYGB, 84% of patients with T2DM experience complete remission of this disease, and virtually all have improved glycemic control. Increasing evidence indicates that the impact of RYGB on T2DM cannot be explained by the effects of weight loss and reduced energy intake alone. Weightindependent antidiabetic actions of RYGB are apparent because of the very rapid resolution of T2DM (before weight loss occurs), the greater improvement of glucose homeostasis after RYGB than after an equivalent weight loss from other means, and the occasional development of very late-onset, pancreatic b-cell hyperfunction. Several mechanisms probably mediate the direct antidiabetic impact of RYGB, including enhanced nutrient stimulation of L-cell peptides (for example, GLP-1) from the lower intestine, intriguing but still uncharacterized phenomena related to exclusion of the upper intestine from contact with ingested nutrients, compromised ghrelin secretion, and very probably other effects that have yet to be discovered. Research designed to prioritize these mechanisms and identify potential additional mechanisms promises to help optimize surgical design and might also reveal novel pharmaceutical targets for diabetes treatment. Keywords: diabetes; gastric bypass; bariatric surgery; ghrelin; GLP-1 Bariatric operations traditionally have been thought to cause weight loss through gastric restriction and/or intestinal malabsorption. Restrictive operations such as adjustable gastric banding (AGB) create a small pouch in the proximal stomach to reduce functional gastric capacity and retard gastric emptying. Malabsorptive procedures such as biliopancreatic diversion (BPD) leave much of the stomach intact but divert ingested food from the stomach to the ileum; thus, only a small segment of the distal bowel can absorb nutrients. The typical proximal Roux-en-Y gastric bypass (RYGB) creates gastric restriction and also causes food to bypass most of the stomach and a short segment of the proximal intestine, primarily the duodenum, leaving enough intact small bowel in digestive continuity to avoid clinically significant malabsorption. RYGB causes weight loss through gastric restriction and additional mechanisms involving changes in gut hormones and other processes under active investigation. 1-14 RYGB and BPD produce the highest and most rapid rates of remission of type 2 diabetes mellitus (T2DM). Remission of diabetes after RYGBAlthough bariatric surgery was designed to facilitate weight loss, anecdotal reports of rapid postoperative remission of T2DM emerged as early as the 1970s. In 1995, Pories et al. 4 reported long term results from 608 severely obese patients who underwent gastric bypass, with a 93% follow-up rate ov...

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“…Bariatric surgery causes durable weight loss, remission or improvement of type 2 diabetes, hypertension, dyslipidemia, sleep apnea, and reduction of cardiovascular disease and death (3)(4)(5)(6). Although weight reduction might in theory explain improvement of insulin resistance and associated conditions, studies in rodents (7)(8)(9) and humans (10,11) showed that the anti-diabetes effect of certain bariatric procedures, particularly gastric bypass surgery, results from mechanisms at least in part independent of weight loss (12)(13)(14).Understanding the mechanisms of action of surgery provides an opportunity to elucidate the pathophysiology of obesity and diabetes and may lead to the development of new treatments of curative intent.…”

Section: Introductionmentioning

confidence: 99%

Surgical control of obesity and diabetes: The role of intestinal vs. gastric mechanisms in the regulation of body weight and glucose homeostasis

Patel

Shukla

Ahn

et al. 2013

Obesity

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Objective: To elucidate the specific role of gastric vs. intestinal manipulations in the regulation of body weight and glucose homeostasis. Design and Methods: The effects of intestinal bypass alone (duodenal-jejunal bypass -DJB) and gastric resection alone (SG) in Zucker Diabetic Fatty (ZDF) rats were compared. Additional animals underwent a combination procedure (SG þ DJB). Outcome measures included changes in weight, food intake (FI), oral glucose tolerance (GT) and gut hormones. Results: DJB did not substantially affect weight and FI, whereas SG significantly reduced weight gain and food consumption. DJB rats showed weight-independent improvement in GT, which improved less after SG. Furthermore, SG significantly suppressed plasma ghrelin and increased insulin, glucagon like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide and peptide YY response to oral glucose whereas DJB had no effects on postprandial levels of these hormones. DJB restored postprandial glucagon suppression in diabetic rats whereas SG did not affect glucagon response. The combination procedure (SG þ DJB) induced greater weight loss and better GT than SG alone without reducing food intake further. Conclusions: These findings reveal a dominant role of the stomach in the regulation of body weight and incretin response to oral glucose whereas intestinal bypass primarily affects glucose homeostasis by a weight-, insulin-and incretin-independent mechanism Obesity (2014) 21, 159-169.

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Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22–34 kg/m2: a report of 2 cases

Cited by 195 publications

References 11 publications

The effect of bilio-pancreatic diversion on type 2 diabetes in patients with BMI <35 kg/m2

The effect of bilio-pancreatic diversion on type 2 diabetes in patients with BMI <35 kg/m2

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

Surgical control of obesity and diabetes: The role of intestinal vs. gastric mechanisms in the regulation of body weight and glucose homeostasis

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