Article

Surgical Endoscopy

, Volume 29, Issue 3, pp 723-733

First online:

The effect of duodenojejunostomy and sleeve gastrectomy on type 2 diabetes mellitus and gastrin secretion in Goto-Kakizaki rats

  • Eivind GrongAffiliated withDepartment of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU) Email author 
  • , Ingerid Brænne ArboAffiliated withDepartment of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU)
  • , Ole Kristian Forstrønen ThuAffiliated withDepartment of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU)
  • , Esther KuhryAffiliated withDepartment of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU)Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University HospitalNational Center for Advanced Laparoscopic Surgery (NSALK), St. Olavs Hospital, Trondheim University Hospital
  • , Bård KulsengAffiliated withDepartment of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU)Regional Center for Morbid Obesity (RSSO), St. Olavs Hospital, Trondheim University Hospital
  • , Ronald MårvikAffiliated withDepartment of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU)Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University HospitalRegional Center for Morbid Obesity (RSSO), St. Olavs Hospital, Trondheim University HospitalNational Center for Advanced Laparoscopic Surgery (NSALK), St. Olavs Hospital, Trondheim University Hospital

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Abstract

Background

Bariatric surgery is a highly effective treatment of type 2 diabetes in patients with morbid obesity. The weight-loss independent improvement of glycemic control observed after these procedures has led to the discussion whether bariatric surgery can be introduced as treatment for type 2 diabetes in patients with a body mass index < 35 kg/m2. We have studied the effects of two bariatric procedures on type 2 diabetes and on gastrointestinal hormone secretion in a lean diabetic animal model.

Methods

Male Goto-Kakizaki rats, 17–18 weeks old, were randomized into three groups: duodenojejunostomy (DJ), sleeve gastrectomy (SG), or sham operation. During 36 postoperative weeks we evaluated body weight, fasting blood glucose, glucose tolerance, insulin, HbA1c, glucagon-like peptide 1, cholesterol parameters, triglycerides, total ghrelin, and gastrin.

Results

Oral glucose tolerance was significantly improved for both DJ and SG at four weeks after surgery (p < 0.05). At the 34th postoperative week, SG had significantly lower area under the curve during oral glucose tolerance test compared to sham (p = 0.007). SG had significantly lower HbA1c compared to sham at 12 weeks; (mean ± SEM) 4.3 ± 0.1 % versus 5.2 ± 0.3 % (p < 0.05) and compared to both DJ and sham 34 weeks after surgery [median (75 %;25 %)] 5.2 (6.0; 4.3) % versus 7.0 (7.5; 6.7) % and 7.3 (7.6; 6.7)  % (p = 0.009). Serum gastrin levels were markedly elevated for SG compared to DJ and sham; 188.0 (318.0; 121.0) versus 77.5 (114.0; 58.0) and 68.0 (90.0; 59.5) pmol/L (p = 0.004) at six weeks and 192.0 (587.8; 110.8) versus 65.5 (77.0; 59.0) and 69.5 (113.0; 55.5) (p = 0.001) 36 weeks after surgery.

Conclusion

Sleeve gastrectomy induces hypergastrinemia, lowers HbA1c, and improves glycemic control in Goto-Kakizaki rats. Sleeve gastrectomy is superior to duodenojejunostomy as treatment of type 2 diabetes mellitus in this animal model.

Keywords

Duodenojejunostomy Sleeve gastrectomy Type 2 diabetes mellitus Gastrin Glucagon-like peptide 1 Goto-Kakizaki rat