Surgery for Nonobese Type 2 Diabetic Patients: An Interventional Study with Duodenal–Jejunal Exclusion

Geloneze, Bruno; Geloneze, Sylka Rodovalho; Fiori, Carla; Stabe, Christiane; Tambascia, Marcos Antônio; Chaim, Élinton Adami; Astiarraga, Brenno; Pareja, José Carlos

doi:10.1007/s11695-009-9844-4

Cited by 91 publications

(58 citation statements)

References 25 publications

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“…While investigating the mechanisms of action for gastrointestinal diversion procedures using duodenojejunal bypass, it was suggested that the exclusion of the duodenum and proximal jejunum would change nutrient movement, thus preventing the stimulation of the inappropriate signal that would promote insulin resistance 13,25,26 . Rubino et al 25 reported that duodenal exclusion of nutrient movement is the critical component for this reduction and subsequent control of diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

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Biliopancreatic diversion with duodenojejunal exclusion associated with truncal vagotomy: a new proposal for type 2 diabetes mellitus treatment

Alleotti¹,

Palma²,

Pinto³

et al. 2012

Acta Cir. Bras.

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PURPOSE: To evaluate the effectiveness of the biliopancreatic diversion surgery with duodenojejunal exclusion in combination with truncal vagotomy in type 2 diabetes mellitus (T2DM) patients with overweight or class I or II obesity. METHODS: The study included ten patients with T2DM and class I or II obesity or overweight who were subjected to biliopancreatic diversion with duodenojejunal exclusion in combination with truncal vagotomy. The blood glucose levels during the pre- and postoperative periods were compared using the Friedman test. The significance level adopted was 5%. RESULTS: There were significant differences between preoperative and postoperative blood glucose levels at three months (p=0.01), six months (p=0.001) and 12 months (p=0.001). There was also a significant difference between one month postoperative blood glucose and six months postoperative blood glucose (p=0.01). Glycosylated hemoglobin levels decreased in 80% of patients, there was marked improvement in their lipid profiles, and the average BMI reduction was 7.0±1.5 kg/m² at 12 months after the surgery. CONCLUSION: In patients with type 2 diabetes mellitus associated with class I/II obesity or overweight, performing biliopancreatic diversion with duodenojejunal exclusion in combination with truncal vagotomy resulted in glycemic control, reduction of excess weight, and improvement of lipid profile 12 months after the surgery.

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Section: Discussionmentioning

confidence: 99%

“…Geloneze et al 26 compared the potential advantages of the duodenojejunal exclusion surgery. Thus, a group of patients was operated upon using this technique and was compared to another paired control group that received the standard medical treatment for T2DM.…”

Section: Discussionmentioning

confidence: 99%

Biliopancreatic diversion with duodenojejunal exclusion associated with truncal vagotomy: a new proposal for type 2 diabetes mellitus treatment

Alleotti¹,

Palma²,

Pinto³

et al. 2012

Acta Cir. Bras.

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“…The operation does more than just limit intake, but also removes most-or perhaps all-of the ghrelin-producing cells in the gastric mucosa. In addition, two new procedures-the duodenojejunal bypass stomach-sparing operation [26] and ileal transposition [27][28][29]-have been tested in attempts to induce remission of diabetes without weight loss in lean or only modestly overweight patients with T2DM. However, both are still in the early stages of human trials (see Perspectives below).…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…Recent animal investigations using duodenojejunal bypass, a stomach-preserving experimental model of RYGB, have shown that diabetes control is not a mere collateral effect of the treatment of obesity, but directly results from exclusion of the duodenum and proximal jejunum from the flow of nutrients. A recent report has described lean T2DM patients who experienced marked improvement of their diabetes with duodenojejunal exclusion surgery that was independent of changes in BMI, fat distribution and body composition [26]. Such a surgical approach was superior to standard care in achieving better glycaemic control, along with reduction or even interruption in insulin requirements.…”

Section: Perspectivesmentioning

confidence: 99%

Bariatric surgery in patients with Type 2 diabetes: benefits, risks, indications and perspectives

Scheen

Flines

Roover³

et al. 2009

Diabetes & Metabolism

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Obesity plays a key role in the pathophysiology of type 2 diabetes (T2DM), and weight loss is a major objective, although difficult to achieve with medical treatments. Bariatric surgery has proven its efficacy in obtaining marked and sustained weight loss, and is also associated with a significant improvement in glucose control and even diabetes remission. Roux-en-Y gastric bypass appears to be more effective in diabetic patients than the restrictive gastroplasty procedure. This may be explained not only by greater weight reduction, but also by specific hormonal changes. Indeed, increased levels of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) may lead to improved β-cell function and insulin secretion as well as reduced insulin resistance associated with weight loss. The presence of T2DM in obese individuals is a further argument to propose bariatric surgery, and even more so when diabetes is difficult to manage by medical means and other weight-related complications are present. Bariatric surgery is associated with a better cardiovascular prognosis and reduced mortality, even though acute and long-term complications may occur. The observation that surgical rerouting of nutrients triggers changes in the release of incretin hormones that, in turn, ameliorate the diabetic state in the absence of weight loss has led to the recent development of innovative surgical procedures. Thus, bariatric surgery may be said to be progressing towards so-called 'metabolic surgery', which merits further evaluation in patients with T2DM within a multidisciplinary approach that involves both surgeons and endocrinologists.Keywords : Bariatric surgery ; Gastric bypass ; Gastroplasty ; Obesity ; Type 2 diabetes ; Review RésuméChirurgie bariatrique chez les patients atteints de diabète de type 2: bénéfices, risques, indications et perspectives L'obésité joue un rôle-clé dans la physiopathologie du diabète de type 2 (DT2) et l'obtention d'une perte de poids est un objectif majeur, bien que difficile à atteindre avec les moyens médicaux. La chirurgie bariatrique a apporté la preuve de son efficacité pour induire un amaigrissement marqué et soutenu, qui s'accompagne d'une amélioration du contrôle glycémique et assez souvent d'une remission du diabète. La dérivation gastrique avec l'anse de Roux-en-Y apparaît être plus efficace chez les patients diabétiques que la simple technique restrictive qu'est la gastroplastie calibrée. Ceci peut s'expliquer non seulement par une perte pondérale supérieure, mais aussi par des modifications hormonales spécifiques. En effet, une augmentation des concentrations de GLP-1 (glucagon-like peptide-1) et de GIP (glucose-dependent insulinotropic polypeptide) avec la dérivation permet d'améliorer la fonction de la cellule β et la réponse insulinosécrétoire, en plus de la diminution de l'insulinorésistance consécutive à l'amaigrissement. La présence d'un DT2 chez un sujet obèse est un argument supplémentaire pour proposer une chirurgie bariatrique, d'autant plus qu...

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“…The absence of the alleged "anti-incretin" in circulation would enhance the action of incretins and thus improve DM2. [101][102][103][104][105] Several authors claim to have demonstrated that derivation of the digestive transit to exclude a short segment of the proximal small intestine alone provides an improvement in diabetes mellitus type 2, irrespective of the effects of restricted food intake, loss of body weight, possible malabsorption of foods or the arrival of a smaller amount of digested food in the distal small intestine. Based on their results, these authors advocate surgery with duodenal exclusion as a valid alternative for the treatment of diabetes mellitus type 2.…”

Section: Introductionmentioning

confidence: 99%

Organic consequences of ileal transposition in rats with diet-induced obesity

et al. 2011

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INTRODUCTION:The clinical management of metabolic syndrome -especially diabetes mellitus type 2 -is notoriously complex due to the progressive nature of this disease. At present, there is a need for a surgical procedure that is effective for the treatment of diabetes mellitus type 2, even in non-obese individuals. The isolated ileal transposition theory could lead to an effective alternative therapy. This intervention has not yet been performed in humans, and there are no reports of its use in an experimental model of diet-induced metabolic syndrome. OBJECTIVES:The objective of this study is to evaluate the physiological effects of ileal transposition in rats with diet-induced metabolic syndrome. The effects of this procedure on glucose and lipid metabolism will be assessed. METHODS:Forty 12-week-old male rats (albino Rattus norvegicus, Wistar, 2BAW, heterogeneous) will be divided into four groups of 10 animals each: the ileal transposition group (TG) comprising animals on a hypercaloric-hyperlipidic diet; the sham group (SG) containing animals that receive the same diet and undergo the sham surgery; control group 1 (CG1), which will receive a hypercaloric-hyperlipidic diet and will not undergo surgery; and control group 2 (CG2), which will consume standard feed and will not undergo surgery. The surgeries will be performed in 20-week-old animals.Blood samples for laboratory testing will be collected from 12-week-old animals on the day of surgery and after eight postoperative weeks, following determination of the weights of the animals and the administration of anesthesia. The levels of serum glucose, insulin, triglycerides, total cholesterol and fractions, glucagon-like peptide-1, C-peptide and glycated hemoglobin will be assessed in all of the animals. The insulin tolerance test will be performed using PRISMA software, and insulin resistance will be calculated by the HOMA-IR indirect test. On specific days, two 20-week-old rats will be separated and randomly distributed in TG and SG. These animals will be followed until the eighth postoperative week. Subsequently, they will be euthanized, and the retroperitoneal and periepididymal fat deposits will be collected and weighed using a precision scale. In addition, the pancreas, liver and intestinal segments will be sent for pathological and immunohistochemical studies.

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Surgery for Nonobese Type 2 Diabetic Patients: An Interventional Study with Duodenal–Jejunal Exclusion

Abstract: In conclusion, duodenal-jejunal exclusion was an effective treatment for nonobese T2DM subjects. GJB was superior to standard care in achieving better glycemic control along with reduction in insulin requirements.

Cited by 91 publications

References 25 publications

Biliopancreatic diversion with duodenojejunal exclusion associated with truncal vagotomy: a new proposal for type 2 diabetes mellitus treatment

Biliopancreatic diversion with duodenojejunal exclusion associated with truncal vagotomy: a new proposal for type 2 diabetes mellitus treatment

Bariatric surgery in patients with Type 2 diabetes: benefits, risks, indications and perspectives

Organic consequences of ileal transposition in rats with diet-induced obesity

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