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Endoscopic Duodenal–Jejunal Bypass Liner Rapidly Improves Type 2 Diabetes

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Abstract

Background

Bariatric procedures excluding the proximal small intestine improve glycemic control in type 2 diabetes within days. To gain insight into the mediators involved, we investigated factors regulating glucose homeostasis in patients with type 2 diabetes treated with the novel endoscopic duodenal–jejunal bypass liner (DJBL).

Methods

Seventeen obese patients (BMI 30–50 kg/m2) with type 2 diabetes received the DJBL for 24 weeks. Body weight and type 2 diabetes parameters, including HbA1c and plasma levels of glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon, were analyzed after a standard meal before, during, and 1 week after DJBL treatment.

Results

At 24 weeks after implantation, patients had lost 12.7 ± 1.3 kg (p < 0.01), while HbA1c had improved from 8.4 ± 0.2 to 7.0 ± 0.2 % (p < 0.01). Both fasting glucose levels and the postprandial glucose response were decreased at 1 week after implantation and remained decreased at 24 weeks (baseline vs. week 1 vs. week 24: 11.6 ± 0.5 vs. 9.0 ± 0.5 vs. 8.6 ± 0.5 mmol/L and 1,999 ± 85 vs. 1,536 ± 51 vs. 1,538 ± 72 mmol/L/min, both p < 0.01). In parallel, the glucagon response decreased (23,762 ± 4,732 vs. 15,989 ± 3,193 vs. 13,1207 ± 1,946 pg/mL/min, p < 0.05) and the GLP-1 response increased (4,440 ± 249 vs. 6,407 ± 480 vs. 6,008 ± 429 pmol/L/min, p < 0.01). The GIP response was decreased at week 24 (baseline—115,272 ± 10,971 vs. week 24—88,499 ± 10,971 pg/mL/min, p < 0.05). Insulin levels did not change significantly. Glycemic control was still improved 1 week after explantation.

Conclusions

The data indicate DJBL to be a promising treatment for obesity and type 2 diabetes, causing rapid improvement of glycemic control paralleled by changes in gut hormones.

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Acknowledgments

The authors would like to thank the patients contributing to this trial; the trial nurses, Y. Wils and R. Nelissen; the students who helped in conducting this research: G. Latten, N. Geubbels, M. de Wolf, T. van der Horst, R. Erbil, B. van der Putten, H. D’Agnolo, S. Peeters Weem, and M.A. Joosten; B. Winkens for statistical assistance; Dr. R.J. de Ridder, Dr. G.H. Koek, and Dr. C.M. Bakker for their help with the DJBL procedures; Prof. Dr. A.A. Masclee, Dr. J. Maljaars, and Y. Slaats for their help regarding the study design; and I.C. Arts and E. Theunisz for the Luminex analyses.

Conflict of Interest

N.D.B. received an open research grant from GI Dynamics. J.W.M.G. received an open research grant and support for travel to meetings for the study or other purposes from GI Dynamics. All other authors have no conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Department of General Surgery and NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Charlotte de Jonge, Sander S. Rensen, Froukje J. Verdam, Wim A. Buurman & Nicole D. Bouvy

  2. Department of General Surgery, Atrium Medical Center Parkstad, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands

    Charlotte de Jonge & Jan Willem M. Greve

  3. Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS, London, UK

    Royce P. Vincent

  4. Department of Medicine, Imperial College London, Du Cane Road, W12 0NN, London, UK

    Steve R. Bloom & Carel W. le Roux

  5. Department of Internal Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Nicolaas C. Schaper

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  1. Charlotte de Jonge
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  2. Sander S. Rensen
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  9. Nicole D. Bouvy
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Correspondence to Jan Willem M. Greve.

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de Jonge, C., Rensen, S.S., Verdam, F.J. et al. Endoscopic Duodenal–Jejunal Bypass Liner Rapidly Improves Type 2 Diabetes. OBES SURG 23, 1354–1360 (2013). https://doi.org/10.1007/s11695-013-0921-3

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  • DOI: https://doi.org/10.1007/s11695-013-0921-3

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