Effects Of Gastrointestinal Bypass Surgery On Treatment And Glucose Transporters In Type2Diabetes Mellitus

1Effects of Roux-en-Y gastric bypass vs. duodenal-jejunal bypass in individuals with BMI<35kg/m2and type2diabetes mellitusObjective:Roux-en-Y gastric bypass and duodenal-jejunal bypass surgery have been widely used in individuals with BMI<35kg/m2and type2diabetes mellitus. The objectives are to compare the efficacy, saf-ety and effects on glucose and lipid metabolism of the two gastrointestinal bypass surgical procedures performed in patients with BMI<35kg/m2and type2diabetes in our institution.Methods:Forty-seven patients of T2DM were divided into three groups (A, B and C). Patients in group A underwent duodeno-jejunal bypass and those in groups B and C underwent Roux-en-Y gastric bypass with the stomach transected at10cm and15cm above the pyloric margin respectively. Indexes for glucose and lipid metabolism were tested pre-operatively and at12months after surgery.Results:At12months after sugery, all47patients demonstrated an improved blood glucose level at least to some extent:resolution by25.5%, glycemic control by48.9%, and improvement by25.5%of the patients. There was no significant difference in the therapeutic effects among the three groups. Although the decrease in insulin and HOMA-β (a measure of pancreatic β-cell function) were not statistically significant, there was a significant decrease in the levels of postoperative fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), postprandial2-hr blood glucose, homeostasis model assessment for insulin resistance (HOMA-IR) and body mass index (BMI). There was no significant difference in the postoperative indicators of lipid metabolism in the three groups except for triglycerides (TG, P=0.004). Triglycerides decreased over one year in all groups, but the decrease was statistically significant only in groups B and C. The operation was successful in all47patients and there was no significant difference in the postoperative complications (P>0.05).Conclusion:Our results suggested that both the Roux-en-Y gastric bypass and duodeno-jejunal bypass improve glucose metabolism in patients with BMI<35kg/m2and T2DM. In addition, Roux-en-Y gastric bypass effectively improved lipid metabolism.There are totally5figures,6tables and25references. 2Effects of duodenal-jejunal bypass on Glucose transporters in GK ratsObjective:Duodenal-jejunal bypass surgery can improve the blood glucose levels in GK rats. The objectives are to test the levels of GLP-1and the expression of SGLT-1, GLUT2, GLUT5and the taste receptor system T1R2, T1R3, Ga gust on the residual bowel segment of type2diabetic GK rats after duodenal-jejunal bypass.Methods:Duodenal-jejunal bypass procedures were performed on Goto-Kakizaki (GK) rats and were observed for three months after surgery. Levels of blood glucose and GLP-1were measured pre-operatively and at1month and3months after the procedure. GLP-1was tested by ELISA Kit competition method. The expression of SGLT-1, GLUT2, and GLUT5was detected by RT-PCR and that of SGLT-1, GLUT2, GLUT5and the taste receptor system T1R2, T1R3, Ga gust protein was detected by Western-blot.Results:Postoperative fasting plasma glucose (FPG) and glycosylated hemoglobin (HbAlc) were significantly reduced for GK rats which underwent duodenal-jejunal bypass both at1month and3months after the procedure (P<0.05). Compared to the sham-operated rats, the GK rats which underwent duodenal-jejunal bypass had a significant increase in GLP-1at one month time, which was even more enhanced at three months after the operation. An upregulation in the expression of SGLT-1, downregulation in the expression of GLUT2, GLUT5and no change in the expression of taste receptor T1R2, T1R3and Gαgust in the residual intestine of GK rats which underwent duodenal-jejunal bypass, was noted.Conclusion:Duodenal-jejunal bypass improved the blood glucose in Gk rats, increased the secretion of GLP-1, upregulated the expression of SGLT-1, downregulated the expression of GLUT2, GLUT5and had no influence on the expression of taste receptors T1R2, T1R3, Gαgust in the residual intestine of GK rats.There are totally20figures,5tables and31references.