Compared to Sleeve Gastrectomy, Duodenal-Jejunal Bypass with Sleeve Gastrectomy Gives Better Glycemic Control in T2DM Patients, with a Lower beta-Cell Response and Similar Appetite Sensations: Mixed-Meal Study

作者：Zachariah Pulimuttil James; Chen Chih Yen; Lee Wei Jei^*; Chen Shu Chu; Ser Kong Han; Chen Jung Chien; Lee Yi Chih

来源：Obesity Surgery, 2016, 26(12): 2862-2872.

DOI：10.1007/s11695-016-2205-1

• Sleeve gastrectomy
• Metabolic surgery
• Duodenal-jejunal bypass
• beta-cell response
• Mixed-meal tolerance test

Background Functional studies of how duodenal-jejunal exclusion (DJE) brings a superior glycemic control when added to sleeve gastrectomy in duodenal-jejunal bypass with sleeve gastrectomy (DJB-SG) patients, are lacking. To study this, we compared the appetite sensations and the beta-cell response following a standard mixed meal in patients with DJB-SG, versus those with sleeve gastrectomy (SG) alone.
Methods Twenty one patients who underwent DJB-SG and 25 with SG, who participated in mixed-meal tests (MMTT) preoperatively and at 1 year, with complete data were included and compared. Blood glucose, C-peptide, and insulin levels were estimated, along with the visual analogue scale (VAS) scoring of the six appetite sensations, as a part of the MMTT.
Results At 1 year following surgery, compared to SG group, DJB-SG group had greater complete remission rates (HbA1C < 6.0 %) of 62 versus 32 % (p<0.05), with similar total body weight loss (25.7 vs. 22 %). There were significantly lower post-prandial blood glucose and lower C-peptide levels during the MMTT in the patients with DJB-SG compared to SG group. There were no significant differences in the appetite sensations (mean VAS) scores between the groups.
Conclusion The addition of DJE component to SG, as in DJB-SG, was associated with higher diabetes remission rates, lower glycemic fluctuations, and lower C-peptide levels. This may point to a beta-cell preserving glucose control which could result in longer remission of type 2 diabetes mellitus (T2DM). This effect also may be unrelated to food intake as there were no significant differences in the appetite sensations.

• 出版日期2016-12