Surgical Endoscopy

, Volume 29, Issue 3, pp 723–733

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

  • Eivind Grong
  • Ingerid Brænne Arbo
  • Ole Kristian Forstrønen Thu
  • Esther Kuhry
  • Bård Kulseng
  • Ronald Mårvik
Article

DOI: 10.1007/s00464-014-3732-2

Cite this article as:
Grong, E., Arbo, I.B., Thu, O.K.F. et al. Surg Endosc (2015) 29: 723. doi:10.1007/s00464-014-3732-2

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

DuodenojejunostomySleeve gastrectomyType 2 diabetes mellitusGastrinGlucagon-like peptide 1Goto-Kakizaki rat

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Eivind Grong
    • 1
  • Ingerid Brænne Arbo
    • 2
  • Ole Kristian Forstrønen Thu
    • 1
  • Esther Kuhry
    • 1
    • 3
    • 5
  • Bård Kulseng
    • 1
    • 4
  • Ronald Mårvik
    • 1
    • 3
    • 4
    • 5
  1. 1.Department of Cancer Research and Molecular Medicine, Faculty of MedicineNorwegian University of Science and Technology (NTNU)TrondheimNorway
  2. 2.Department of Circulation and Medical Imaging, Faculty of MedicineNorwegian University of Science and Technology (NTNU)TrondheimNorway
  3. 3.Department of Gastrointestinal SurgerySt. Olavs Hospital, Trondheim University HospitalTrondheimNorway
  4. 4.Regional Center for Morbid Obesity (RSSO)St. Olavs Hospital, Trondheim University HospitalTrondheimNorway
  5. 5.National Center for Advanced Laparoscopic Surgery (NSALK)St. Olavs Hospital, Trondheim University HospitalTrondheimNorway