The Effect of 6 and 12 months Duodenal-Jejunal Bypass Liner Treatment on Obesity and Type 2 Diabetes: a Crossover Cohort Study

Abstract

Objective The aim of this research was to study the duodenaljejunal bypass liner (DJBL) treatment for obesity and type 2 diabetes mellitus (T2DM) in patients after dietary treatment in a cross-over design. Background DJBL treatment has been proven effective for treatment of obesity and T2DM. However, data on safety and efficacy of a 12-month DJBL treatment is limited. Methods In 2014, our research group reported on a multicenter randomized clinical trial. Patients were randomized to DJBL or dietary treatment (control group). Twenty-eight patients crossed over after their dietary treatment and received up to 12 months of DJBL treatment. Patient visits were conducted at baseline, during DJBL treatment (1 week, 1-6, 9, 12 months) and 6 months after removal of the liner. Patients underwent a standard physical examination, blood sampling, assessment of adverse events, nutritional and diabetes counseling, and a standardized meal tolerance test. Results Of the 28 patients included in this study, 24 patients completed 6 months of treatment. Eighteen patients were extended to 12 months of DJBL treatment; 13 patients completed this treatment period. After 6 months of DJBL treatment, a significant increase in excess weight loss (EWL) and decrease in weight, BMI, HbA1c, fasting glucose, cholesterol, HDL and LDL improved significantly. After 12 months of DJBL treatment, these parameters stabilized. Conclusions The DJBL is an effective, minimally invasive treatment option. Even after successful treatment with dietary restrictions, the DJBL is still capable of significantly reducing weight and improving cardiovascular and type 2 diabetes mellitus parameters in obese patients.

Temporal Associations Among Body Mass Index, Fasting Insulin, and Systemic Inflammation

“…Of these, 753 articles were excluded, resulting in 60 that met the selection criteria and 5603 enrolled participants (of whom 5261 were analyzed). 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 ...…”

“…A total of 90% of the studies were in populations with metabolic disease or conditions associated with metabolic disease: obesity, 25 , 32 , 33 , 34 , 37 , 41 , 43 , 45 , 47 , 48 , 49 , 52 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 76 , 77 , 79 , 80 , 81 , 82 , 83 diabetes or prediabetes, 26 , 32 , 38 , 46 , 59 hypertension, 40 coronary artery disease, 65 dyslipidemia, 51 chronic kidney disease, 78 nonalcoholic fatty liver disease, 31 , 35 Cushing disease, 36 polycystic ovary syndrome, 61 breast cancer, 28 , 56 , 82 and aging (ie, college students 84 ). Of the patients in these 54 studies, 22 (41%) had undergone bariatric surgery as the studied intervention (n = 14) or as part of the required eligibility criteria (n = 8).…”

“…A total of 21 studies were from Western Europe, 25,27,41,54,61,62,65,72,81,82,84 11 from North America, 25,27,41,54,61,62,65,72,81,82,84 9 from East Asia, 29,38,39,44,51,52,60,66,68 5 from South America, 28,69,78,79,83 5 from Western Asia, 28,69,78,79,83 and 3 each from Africa, 35,50,76 the Pacific, 26,42,75 and Eastern Europe. 45,74,80 A total of 90% of the studies were in populations with metabolic disease or conditions associated with metabolic disease: obesity, 25,[32][33][34]37,41,43,45,[47][48]…”

Bypassed and Preserved Stomach Resulted in Superior Glucose Control in Sprague-Dawley Rats with Streptozotocin-Induced Diabetes

“…However, the diabetes remission outcomes following a stand-alone foregut exclusion procedure, such as duodenal-jejunal bypass (DJB), remains inconclusive. While some studies have reported that DJB resulted in effective anti-diabetic outcomes 5,6 , several other studies have also suggested that DJB is still ineffective to induce diabetes remission 7–10 . The unconvincing reports on the anti-diabetic effect of DJB is interesting because RYGB continued to demonstrate significant diabetes remission outcomes 11 .…”

Characterization of Artifact Influence on the Classification of Glucose Time Series Using Sample Entropy Statistics

“…The clinical implications of such a classifier can be varied and diverse. Changes in glucose dynamics could be correlated with other anthropometric, biochemical or hormonal characteristics [ 44 , 45 ] in order to try to anticipate the rate and intensity of metabolic improvements after the exclusion and better understand the possible mechanisms of its effects. It could also be used as a screening tool for patient/treatment selection.…”