Scientific paper
The effects of duodenal-jejunal exclusion on hormonal regulation of glucose metabolism in Goto-Kakizaki rats

https://doi.org/10.1016/j.amjsurg.2006.11.015Get rights and content

Abstract

Background

The antidiabetic effect of bariatric surgery has been interpreted as a conceivable result of surgically induced weight loss and decreased caloric intake. However, glycemic control often occurs within days, before significant weight loss has been reached. The aim of our work was to investigate the hormones that control glycemic status in diabetes mellitus after a duodenal-jejunal exclusion in an animal model of nonobese type 2 diabetes.

Methods

Twelve (12- to 14-week-old) rats (Goto-Kakizaki) randomly underwent one of the following procedures: gastrojejunal bypass (group 1, n = 6) or no intervention (controls) (group 2, n = 6). Both groups were fed with the same type and amount of diet. At basal time (preoperative) and after intervention (1 week and 1 month), weight and fasting glycemia were measured. An oral glucose tolerance test (OGTT) was realized at same times. Hormone levels (insulin, glucagons-like petide 1 [GLP-1], glucose-dependent insulinotropic peptide [GIP], glucagon, and leptin) were measured after 20 minutes of oral glucose overload. Age-matched Goto-Kakizaki rats were used as controls for all variables.

Results

Rats in group 1 and group 2 remained with the same weight during the protocol. The OGTT showed an improvement in glycemic levels in group 1; glucose levels were better at 1 week and 1 month after the surgery in all times of OGTT (basal, 10 minutes, and 120 minutes). Basal glucose levels at time 0 in basal time, at 1 week, and at 1 month were lower in group 1 than group 2. Postoral glucose overload levels of glucagon, insulin, GLP-1, and GIP remained unchaged during the treatment in both groups. In group 1, leptin levels had a significant decrease at 1 week and 1 month after surgery (basal time (6.1 ± 1.6 ng/mL) versuss 1 week (0.9 ± 0.9 ng/mL) versus 1 month (0.7 ± 0.6 ng/mL) (P < .05).

Conclusion

Gastrojejunal bypass in a nonobese diabetic model improves glycemic control with a significant decrease in leptin levels, without changes in enteroinsular axis (GLP-1, GIP, glucagons, and insulin levels).

Section snippets

Animals and diet

Twelve male Goto-Kakizaki rats who were 10 to 12 weeks of age were purchased from Taconic M&B A/S (Copenhagen, Denmark). Male rats were used to avoid hypothetical ovarian cycle effects on enteroinsular hormone levels. Animals had free access to tap water and were fed with 20 to 25 g per day of 5% fat rat chow diet (Altromin 04; Altromin, Gesellschaft, Germany) during all the protocol. The study was approved by Investigation Commette of the Hospital.

Experimental protocol

After the rats were aclimated for 2 weeks,

Results

Before treatment, there were no significant differences between groups in terms of weight (group 1: 259 ± 45.6 g versus group 2: 263.3 ± 26.4 g, not significant) or fasting glycemia (group 1: 260.6 ± 128 mg/dL versus group 2: 249.4 ± 47.7 mg/dL, not significant). In group 1, weight did not show intragroup differences during follow-up (basal 249.4 ± 47.7 g versus 1 week 290.3 ± 45 g versus 1 month 314.6 ± 40 g, not significant). In group 2, weight was similar during the study (basal 263.3 ± 26.4

Comments

Our data show that the bypass of the duodenum and proximal jejunum reduces fasting glycemia and improves glucose tolerance test, with a significant paradoxical decrease of leptin levels after surgery.

The first consideration of our study is that the control of diabetes mellitus induced by duodenal-jejunal exclusion is not dependent on the weight reduction because weight of rats remained unchanged and our model is a nonobese model [10]. In our study, the effect on glucose metabolism seems to be a

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