Resolution of diabetes mellitus by ileal transposition compared with biliopancreatic diversion in a nonobese animal model of type 2 diabetes

Abstract

Background: It has been demonstrated that biliopancreatic diversion (BPD) and ileal transposition (IT) effectively induce weight loss and long-term control of type 2 diabetes in morbidly obese individuals. It is unknown whether the control of diabetes is better after IT or after BPD. The objective of this study was to investigate the effects of IT and BPD on the control of diabetes in an animal model. Methods:We performed IT and BPD on 10-to 12-week-old Goto-Kakizaki rats with a spontaneous nonobese model of type 2 diabetes, and we performed a series of detection. The rats were observed for 24 weeks after surgery.Results: Animals who underwent IT and BPD demonstrated improved glucose tolerance, insulin sensitivity and the secretion of glucagon-like peptide-1 compared with the sham-operated animals. Furthermore, IT resulted in a shorter duration of surgery and better postoperative recovery than BPD. Conclusion:This study provides strong evidence for the crucial role of the hindgut in the resolution of diabetes after duodenum-jejunum bypass or IT. We confirmed that IT was associated with better postoperative recovery than BPD and had a similar control of diabetes as BPD in nonobese animals with type 2 diabetes.Contexte : Il a été démontré que la dérivation biliopancréatique (DBP) et la transposition iléale (TI) sont efficaces pour faire perdre du poids et permettent de contrôler à long terme le diabète de type 2 chez les personnes atteintes d'obésité morbide. On ne sait pas si le contrôle du diabète est meilleur après la TI ou après la DBP. Cette étude visait à analyser les effets de la TI et de la DBP sur le contrôle du diabète dans un modèle animal.Méthodes : Nous avons pratiqué une TI et une DBP sur des rats Goto-Kakizaki âgés de 10 à 12 semaines avec un modèle non obèse spontané de diabète de type 2, et nous avons procédé à une série de détections. Les rats ont été observés pendant 24 semaines après l'intervention chirurgicale. Résultats :Chez les animaux qui ont subi une TI et une DBP, la tolérance au glucose, la sensibilité à l'insuline et la sécrétion de peptide-1 de type glucagon a augmenté comparativement à ceux qui ont subi une opération fictive. De plus, pour la TI, l'intervention chirurgicale a été de moindre durée et le rétablissement postopératoire a été meilleur, par rapport à la DBP. Conclusion :Cette étude démontre solidement le rôle crucial que joue l'intestin postérieur dans l'élimination du diabète après un pontage duodénojéjunal ou une transposition iléale. Nous avons confirmé que la TI était associée à un meilleur rétab-lissement après l'intervention que la DBP et permettait de contrôler le diabète de la même façon que la DBP chez les animaux non obèses atteint de diabète de type 2. Diabetes mellitus presently affects more than 170 million people worldwide, with an increase of at least 50% estimated for 2010.1 Prevalence of the disease is expected to reach about 300 million by 2025.2 As the population with type 2 diabetes increases, so does the prevalence of life-threatening complications. By...

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

“…In fact, previous investigations in rodents suggest that elevation of GLP-1 levels may be a late phenomenon after DJB (13)(14)(15)39,40).…”

Myocardial Insulin Signaling and Glucose Transport Are Up-regulated in Goto–Kakizaki Type 2 Diabetic Rats After Ileal Transposition

“…The concept of ileal transposition (IT) was first described in rodent experiments [3]. It has been confirmed that ileal transposition can improve glucose tolerance compared with other bariatric surgeries, was faster to perform, and yielded a shorter recovery time in animal models of non-obese type 2 diabetes [4,5]. These findings strongly suggested that an underlying hormonal mechanism involving the terminal ileum may participate in the resolution of type 2 diabetes after surgery [6,7].…”

Ileal Interposition in Rats with Experimental Type 2 Like Diabetes Improves Glycemic Control Independently of Glucose Absorption

“…A similar reduction of weight increase during the first weeks after IIP and sham surgery has been described for rats on standard diet with low-dose STZ-induced diabetes [ 41 ] and for a genetic type 2 diabetes mellitus rat model [ 48 ]. However, in these experiments, a reduction of body weight after IIP surgery compared to sham surgery was clearly evident after longer postsurgery periods [ 12 , 26 , 29 , 30 , 37 , 38 , 40 , 41 , 43 , 44 , 46 , 47 , 58 , 62 ].…”

“…The data show that IIP surgery improved glucose tolerance and insulin sensitivity in rats with T2LD. Improved glucose tolerance and insulin sensitivity following IIP surgery have been previously reported in two nonobese genetic diabetic models: the Goto-Kakizaki-rats [ 13 , 26 , 38 , 39 ] and the Zucker rats [ 47 ].…”