Effect Of Blood Glucose Decrease After Gastrojejunostomy With Different Types Of Anastomosis On Type 2 Diabetes Mellitus In Goto-Kakizaki Rat

【Objective】To evaluate the effect of fasting blood glucose,glycated hemoglobin, serum insulin levels and the role of insulin resistance index after gastrojejunostomy with different types of anastomosis on type 2 diabetes mellitus in Goto-Kakizaki rats, and to find out which is the best gastrojejunostomy in blood glucose-lowering.【Methods】24 GK type 2 diabetic rats whose three months older were divided into three groups. They randomly underwent one of the following procedures: gastric bypass with different types of anastomosis of Roux-en-Y (n=8), BillrothⅡ(n=8) or BillrothⅠ(n=8). Roux-en-Y gastric bypass underwent partial stomach excision which exclusion duodenum and proximal jejunum; BillrothⅡgastric bypass underwent partial stomach excision which exclusion duodenum and proximal jejunum; BillrothⅠunderwent partial stomach excision which remnant stomach and duodenum coincide. Rats were observed for 24 weeks after surgery. Food intake, body weight, fasting blood glucose level and insulin level were tested at 0, 1, 3, 6, 12, 24 weeks and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated, The glycosylated hemoglobinA1c(HbA1c) were measured in week 8,16,24. The turnover of the diabetes condition in the 6th month after surgery was observed. Compared preoperative and postoperative changes in the index to find the best of the gastrointestinal anastomosis.【Results】1. Blood-glucose Blood glucose of three groups have no difference before operation (P>0.05). Compared with preoperation, fasting blood glucose level similar in BillrothⅠrats during the entire follow-up period (P>0.05). In both Roux-en-Y and BillrothⅡgroups, fasting blood glucose levels were significantly decreased after surgery and then kept a similar level during the entire follow-up period (P<0.01); At the same time, the Roux-en-Y group of fasting blood glucose level was significantly lower than the BillrothⅡgroup (P<0.05).2. Glycosylated hemoglobin(HbA1c): HbA1c of three groups have no difference before operation(P>0.05), Compared with preoperation, HbA1c similar in BillrothⅠrats during the entire follow-up period (P>0.05). In both Roux-en-Y and BillrothⅡgroups, HbA1c were significantly decreased after surgery and then kept a similar level during the entire follow-up period (P<0.01); At the same time, the Roux-en-Y group of HbA1c was significantly lower than the BillrothⅡgroup (P <0.05).3. Fasting blood insulin level: Fasting blood insulin level of three groups have no difference before operation (P>0.05). After operation, the fasting blood insulin levels of three groups were similar during the entire follow-up period (P>0.05). There were no difference between all of the three groups at the same time(P>0.05).4. Insulin resistance (HOMA-IR): HOMA-IR of three groups have no difference before operation(P>0.05). Compared with preoperation, HOMA-IR similar in BillrothⅠrats during the entire follow-up period(P>0.05). In both Roux-en-Y and BillrothⅡgroups, HOMA-IR were significantly decreased after surgery and then kept a similar level during the entire follow-up period (P<0.01); At the same time, the Roux-en-Y group of HOMA-IR was significantly lower than the BillrothⅡgroup (P <0.05).5. Food-intake and Weight: Food-intake and weight of three groups have no difference before operation (P>0.05); Compared with preoperation, the food-intake and weight were decreased as early as 1 week after operation (P<0.01), And the food-intake and weight were increasing gradually during the follow-up period, Until the 6th week they recovered to preoperative level(P>0.05); With the extension of time, the weight is increasing gradually, There were no difference between all of the three groups at the same time(P>0.05);6. Complication after operation: Complication after operation include diarrhoea, there were three appears in Roux-en-Y group, two appears in BillrothⅡgroup and two appears in BillrothⅠgroup. There were no anastomotic leak and bleeding in all of the three groups; And the mortality of the three groups were 0%.【Conclusions】1. BillrothⅡand Roux-en-Y gastrojejunostomy were effective in terms of blood glucose, glycated hemoglobin and insulin resistance index;2. Roux-en-Y gastric bypass is more effective than BillrothⅡgastric bypass in terms of blood glucose, glycated hemoglobin and improved insulin resistance;3. There was no effect to control T2DM in BillrothⅠgastrojejunostomy;4. The therapeutic effect of BillrothⅡand Roux-en-Y gastrojejunostomy were independent on food intake and body weight decreased.