Abstract
AbstractINTRODUCTION: The clinical management of metabolic syndrome - especially diabetes mellitus type 2 - is notoriously complex due to the progressive nature of this disease. At present, there is a need for a surgical procedure that is effective for the treatment of diabetes mellitus type 2, even in non-obese individuals. The isolated ileal transposition theory could lead to an effective alternative therapy. This intervention has not yet been performed in humans, and there are no reports of its use in an experimental model of diet-induced metabolic syndrome. OBJECTIVES: The objective of this study is to evaluate the physiological effects of ileal transposition in rats with diet-induced metabolic syndrome. The effects of this procedure on glucose and lipid metabolism will be assessed. METHODS: Forty 12-week-old male rats (albino Rattus norvegicus, Wistar, 2BAW, heterogeneous) will be divided into four groups of 10 animals each: the ileal transposition group (TG) comprising animals on a hypercaloric-hyperlipidic diet; the sham group (SG) containing animals that receive the same diet and undergo the sham surgery; control group 1 (CG1), which will receive a hypercaloric-hyperlipidic diet and will not undergo surgery; and control group 2 (CG2), which will consume standard feed and will not undergo surgery. The surgeries will be performed in 20-week-old animals. Blood samples for laboratory testing will be collected from 12-week-old animals on the day of surgery and after eight postoperative weeks, following determination of the weights of the animals and the administration of anesthesia. The levels of serum glucose, insulin, triglycerides, total cholesterol and fractions, glucagon-like peptide-1, C-peptide and glycated hemoglobin will be assessed in all of the animals. The insulin tolerance test will be performed using PRISMA software, and insulin resistance will be calculated by the HOMA-IR indirect test. On specific days, two 20-week-old rats will be separated and randomly distributed in TG and SG. These animals will be followed until the eighth postoperative week. Subsequently, they will be euthanized, and the retroperitoneal and periepididymal fat deposits will be collected and weighed using a precision scale. In addition, the pancreas, liver and intestinal segments will be sent for pathological and immunohistochemical studies.
Highlights
The clinical management of metabolic syndrome - especially diabetes mellitus type 2 - is notoriously complex due to the progressive nature of this disease
In 1998, the World Health Organization (WHO) established that metabolic syndrome (MS) is characterized by the association of insulin resistance (IR) or diabetes mellitus type 2 (DM2) with two or more of the following criteria: (1) a blood pressure (BP) greater than or equal to 160/90 mmHg, (2) hyperlipidemia, defined as triglyceride levels above 150 mg/dL and/or high-density lipoprotein (HDL) cholesterol below 35 mg/dL in men and below 39 mg/dL in women, (3) central obesity with a waist/hip ratio of greater than 0.9 in men and greater than 0.85 in women and/or a body mass index (BMI) greater than 30 kg/m2 (4) and microalbuminuria of at least 20 mg/min or an albumin/creatinine ratio greater than 20 mg/g
A prospective controlled study showed that conservative treatment over ten years resulted in an increased body weight of approximately 1.6% compared to a weight loss of 13.2% with the adjustable gastric band and 35% with gastroplasty reduction and gastrojejunal derivation.[15]
Summary
The world‟s population has experienced a significant increase in the prevalence of obesity.[1]. There is a clear need for new, more aggressive antidiabetic therapeutic options, which could be combined with the existing pharmacological agents to preserve the functions of beta cells and halt the progression of diabetes mellitus type 2.147 None of the mentioned available therapies for diabetes mellitus have been shown to preserve the functions of pancreatic beta cells over time The limitations of this treatment demonstrate the importance of discovering new resources that offer greater efficiency, durability, convenience, safety and tolerability to achieve the goals of early adequate glycemic control and the prevention or delay of the need for additional measures.[145] More aggressive options are required based on the pathogenesis of this disease, and such options should include a greater control of both fasting and postprandial glucose.[154]. The surgical treatment of patients with diabetes mellitus type 2, irrespective of obesity, must currently be considered as a valid alternative approach to the treatment of this disease
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