Early Changes in Incretin Secretion After Laparoscopic Duodenal–Jejunal Bypass Surgery in Type 2 Diabetic Patients

Abstract

A stomach-preserving duodenal-jejunal bypass (DJB) has been used for the treatment of type 2 diabetes mellitus (DM) since Rubino et al. first reported a prospective trial. However, there has been no report on changes in incretin secretion after DJB. We aimed to investigate whether DJB changes incretin secretion in nonmorbidly obese type 2 diabetic patients. The inclusion criteria in this prospective study were: patient age of 20-65years, body mass index of <30kg/m(2), a history of type 2 DM for ≤10years, and fasting C-peptide ≥0.3nmol/l. Six patients with type 2 DM without morbid obesity underwent DJB. Fasting plasma glucose and glycated hemoglobin (HbA1c) were measured. An oral glucose tolerance test (OGTT) was performed with measurement of glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), insulin, C-peptide, and glucagon. The study subjects were followed up for 6months. The body weight of patients declined after surgery. The area under the curve (AUC) of glucose, peak glucose levels during OGTT, and HbA1c also declined until 3months postoperatively. The AUC of C-peptide and insulin tended to increase postoperatively. The AUC of glucagon had a significant increase at 6months postoperatively. The AUC of active GLP-1 increased at 1month and at 6months postoperatively. There was no change in the AUC of total GIP. Our data suggest that DJB increases GLP-1 secretion in nonmorbidly obese type 2 diabetic patients. However, long-term data are needed to confirm this finding.