Common Channel Length in Bypass Surgery Does Not Impact T2DM in Diabetic Zucker Rats
Metabolic surgery is known to impact glucose tolerance but the exact mechanism is still unclear. Based on recently-published data, especially the role of the hindgut may require redefinition.
Either a loop duodeno-jejunostomy (DJOS) with exclusion of one third of total intestinal length, a loop duodeno-ileostomy (DiOS, exclusion of two thirds), or SHAM operation was performed in 9-week-old Zucker diabetic fatty rats. One, 3, and 6 months after surgery, an oral glucose tolerance test (OGTT) and glucose-stimulated hormone analyses were conducted. Body weight was documented weekly.
DJOS and DiOS animals showed significantly better glucose control in all OGTTs than the SHAM group (two-way ANOVA p < 0.0001). Body weight developed largely parallel in both intervention groups; SHAM animals had gained significantly less weight after 6 months (Mann-Whitney DJOS/DiOS vs. SHAM p < 0.05, DJOS vs. DiOS p > 0.05). Operative interventions had no impact on GLP-1 and GIP levels at any time point (Mann-Whitney p > 0.05 for all). DJOS/DiOS operations could preserve insulin production up to 6 months, while there was already a sharp decline of insulin levels in the SHAM group (Mann-Whitney: DJOS/DiOS vs. SHAM p < 0.05 for all time points). Additionally, insulin sensitivity was improved significantly 1 month postoperative in both intervention groups compared to SHAM (Mann-Whitney DJOS/DiOS vs. SHAM p < 0.05).
The data of the current study demonstrate a sharp amelioration of glucose control after duodenal exclusion with unchanged levels of GLP-1 and GIP. Direct or delayed hindgut stimulation had no impact on glucose control in our model.
KeywordsDuodeno-enterostomy Type 2 diabetes mellitus Obesity surgery Metabolic surgery
The authors thank Silke Hempel for the outstanding work in assistance with ELISA measurements. Also, we thank Dieter Hauschke for his advice in statistical questions. Moreover, we thank Claudia Bravo and Monika Kolterjahn for the excellent work with animal care.
Compliance with Ethical Standards
All animal experimental protocols were approved by the local Animal Welfare Committee under the auspices of the responsible regional commission. All applicable institutional and national guidelines for the care and use of animals were followed.
Conflict of Interest
The authors declare that they have no conflict of interest.
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