Endoscopic duodenal-jejunal bypass liner rapidly improves type 2 diabetes

Obes Surg. 2013 Sep;23(9):1354-60. doi: 10.1007/s11695-013-0921-3.

Abstract

Background: Bariatric procedures excluding the proximal small intestine improve glycemic control in type 2 diabetes within days. To gain insight into the mediators involved, we investigated factors regulating glucose homeostasis in patients with type 2 diabetes treated with the novel endoscopic duodenal-jejunal bypass liner (DJBL).

Methods: Seventeen obese patients (BMI 30-50 kg/m(2)) with type 2 diabetes received the DJBL for 24 weeks. Body weight and type 2 diabetes parameters, including HbA1c and plasma levels of glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon, were analyzed after a standard meal before, during, and 1 week after DJBL treatment.

Results: At 24 weeks after implantation, patients had lost 12.7 ± 1.3 kg (p < 0.01), while HbA1c had improved from 8.4 ± 0.2 to 7.0 ± 0.2 % (p < 0.01). Both fasting glucose levels and the postprandial glucose response were decreased at 1 week after implantation and remained decreased at 24 weeks (baseline vs. week 1 vs. week 24: 11.6 ± 0.5 vs. 9.0 ± 0.5 vs. 8.6 ± 0.5 mmol/L and 1,999 ± 85 vs. 1,536 ± 51 vs. 1,538 ± 72 mmol/L/min, both p < 0.01). In parallel, the glucagon response decreased (23,762 ± 4,732 vs. 15,989 ± 3,193 vs. 13,1207 ± 1,946 pg/mL/min, p < 0.05) and the GLP-1 response increased (4,440 ± 249 vs. 6,407 ± 480 vs. 6,008 ± 429 pmol/L/min, p < 0.01). The GIP response was decreased at week 24 (baseline-115,272 ± 10,971 vs. week 24-88,499 ± 10,971 pg/mL/min, p < 0.05). Insulin levels did not change significantly. Glycemic control was still improved 1 week after explantation.

Conclusions: The data indicate DJBL to be a promising treatment for obesity and type 2 diabetes, causing rapid improvement of glycemic control paralleled by changes in gut hormones.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Area Under Curve
  • Bariatric Surgery* / methods
  • Blood Glucose / metabolism
  • Body Mass Index
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / metabolism
  • Diabetes Mellitus, Type 2 / surgery*
  • Duodenum / metabolism
  • Duodenum / surgery*
  • Eating
  • Endoscopy*
  • Fasting
  • Female
  • Gastric Inhibitory Polypeptide
  • Glucagon / metabolism
  • Glucagon-Like Peptide 1 / metabolism
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Insulin / metabolism
  • Insulin Secretion
  • Jejunum / metabolism
  • Jejunum / surgery*
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Obesity / epidemiology
  • Obesity / metabolism
  • Obesity / surgery*
  • Pilot Projects
  • Postprandial Period
  • Remission Induction
  • Time Factors
  • Treatment Outcome
  • Weight Loss*

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Insulin
  • hemoglobin A1c protein, human
  • Gastric Inhibitory Polypeptide
  • Glucagon-Like Peptide 1
  • Glucagon