The Study Of Bile Acid And Gut Microbiota In The Treatment Of Type2 Diabetes With Metabolic Surgery

BackgroundCurrently,metabolic surgery is the most effective treatment for obesity with type 2 diabetes(T2D).In recent years,evidence shown that,in addition to diet restriction and weight loss,bile acids could be one independent factors in participating the regulation of glucose metabolism and insulin sensitivity after metabolic surgery,which with the wide cross-talk with gut microbiota.Our study explored the changes between bile acids and gut microbiota in clinical and animal experiments.ObjectivesOur aim was to explore the effect of metabolic surgery on T2D with obesity and bile acids,to identify specific gut microbiota that may contribute to the improvement of T2D after surgery.MethodsPart ?,clinical research226 patients with T2D who underwent laparoscopic gastric bypass(RYGB)and laparoscopic sleeve gastrectomy(SG)were enrolled with retrospective study.Part ?,animal researchEstablish the T2D with obesity rat model with a high-fat diet combined with low-dose streptozotocin.To compare the effects of RYGB and SG on T2D remission and bile acids circulation.To analyze the gut microbiota which improve T2D and play an important role after surgery,the faecal was profiled using 16S ribosomal RNA gene sequencing.ResultsPart ?,clinical research226 patients(121 females)with an average age of 43.8±13.6 years,an average T2D duration of 6.8±5.2 years,and a median follow-up of 25(1-32)months.180 patients underwent RYGB with one case of fistula,one case of obstruction and two cases of anastomotic edema.48 patients underwent SG with two cases of stomach stenosis.T2D and metabolic disorder improved with hypoglycemic and lipid medicine decreased significantly after surgery.Circulating bile acid level was significantly increased after metabolic surgery with associated with body weight,BMI,and subcutaneous fat area.However,RYGB was more effective in treating T2D to SG.Part ?,animal researchThe overall success rate of the rat model was 51.4%.T2D was improved in varying degrees after metabolic surgery while circulating bile acid levels increased steadily.Metabolic surgery can alter the composition and abundance of gut microbiota.The RYGB was more effective than SG in improving body weight,insulin resistance and blood lipid.The increase of circulating bile acid had been observed most significant in the RYGB group.The composition of gut microbiota after RYGB was close to normal rat at Phylus and Class level.Sutterella was significantly elevated in RYGB group and was positively correlated with bile acid level.ConclusionMetabolic surgery can improve T2D and obesity-related metabolic disorders effectively,increase circulating bile acid levels.RYGB was more effective in treating T2D to SG.The composition of gut microbiota after RYGB was close to normal rat.The abundance Sutterella was positively correlated with bile acid level.Sutterella may play an important role in improving T2D after RYGB.