Effect of Ileal Transposition and Roux-en-Y Gastric Bypass on Blood Glucose and Expression of GLP-1 in Rats with Non-Obese Type 2 Diabetes Mellitus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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Department of General Surgery, Wuhan General Hospital of Guangzhou Military Command, Wuhan 430070, Hubei Province, China;

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Keywords：

Type 2 diabetes mellitus; Ileal transposition; Roux-en-Y gastric bypass; Blood glucoses; Glucagon-like peptide-1; Goto-Kakizaki rat

DOI：

10.7507/1007-9424.20160273

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Objective To compare the effect of ileal transposition (IT) and Roux-en-Y gastric bypass (RYGBP) on blood glucose and expression of glucagon-like peptide-1 (GLP-1) in Goto-Kakizaki (GK) rats with non-obese type 2 diabetes mellitus (T2DM). Methods Thirty male GK rats were randomized divided into three groups:IT group (n=10), RYGBP group (n=10), and Sham group (n=10). The mortality and complication were observed after surgery. The levels of fasting blood glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin (HbA1c), and GLP-1 were determined before operation, and 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months after operation in the GK rats of 3 groups. Results ① Mortality and morbility. There was no death and complication occurred in IT group and Sham group, only 5 rats of RYGBP group suffered from complication, and 2 of them died. The mortality and morbility were higher in RYGBP group than those of IT group and Sham group (P < 0.05). ② FBG. Compared with before operation in the same group, the FBG levels of IT group and RYGBP group in 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation were all lower (P < 0.05). In 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation, FBG levels of IT group and RYGBP group were all lower than those of Sham group at the same time point (P < 0.05), but there was no significant difference between IT group and RYGBP group at the 6 time points (P > 0.05). ③ FINS and HbA1c. Compared with before operation in the same group, the FINS levels of IT group and RYGBP group in 3 months and 6 months after operation were higher than those of Sham group (P < 0.05), HbA1c levels of IT group and RYGBP group were both lower at the 2 time points (P < 0.05). In 3 months and 6 months after operation, FINS levels of IT group and RYGBP group were both higher, and HbA1c levels were both lower than corresponding indexes of Sham group at the same time point (P < 0.05), but there was no significant difference between IT group and RYGBP group at the 2 time points (P > 0.05). ④ GLP-1. Compared with before operation in the same group, the GLP-1 levels of IT group and RYGBP group in 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation were all higher (P < 0.05). In 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation, GLP-1 levels of IT group and RYGBP group were both higher than those of Sham group at the same time point (P < 0.05), but there was no significant difference between IT group and RYGBP group at the 6 time points (P > 0.05). Conclusion IT and RYGBP have a significant hypoglycemic effect on non-obese T2DM GK rats, but IT has lower mortality and morbility, which is more effective and safer, comparing with RYGBP.

Citation： CAI Xun, LIU Yong, MA Dan-dan, MEI Hong-liang, ZHANG Jian-xin, SHAO Jun-wei. Effect of Ileal Transposition and Roux-en-Y Gastric Bypass on Blood Glucose and Expression of GLP-1 in Rats with Non-Obese Type 2 Diabetes Mellitus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(9): 1056-1060. doi: 10.7507/1007-9424.20160273 Copy

1.	Wild S, Roglic G, Green A, et al. Global prevalence of diabetes:estimates for the year 2000 and projections for 2030. Diabetes Care, 2004, 27(5):1047-1053.
2.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會.中國肥胖和2型糖尿病外科治療指南(2014).中國實用外科雜志, 2014, 34(11):1005-1010.
3.	Detournay B, Cros S, Charbonnel B, et al. Managing type 2 diabetes in France:the ECODIA survey. Diabetes Metab, 2000, 26(5):363-369.
4.	Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg, 1995, 222(3):339-352.
5.	Wang TT, Hu SY, Gao HD, et al. Ileal transposition controls diabetes as well as modified duodenal jejunal bypass with better lipid lowering in a nonobese rat model of type Ⅱ diabetes by increasing GLP-1. Ann Surg, 2008, 247(6):968-975.
6.	Depaula AL, Macedo AL, Mota BR, et al. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21-29. Surg Endosc, 2009, 23(6):1313-1320.
7.	田曉豐, 曹宏, 陳丹磊, 等.胃旁路術對非肥胖2型糖尿病大鼠降血糖作用機制的初步研究.中國實驗診斷學, 2010, 14(6):833-835.
8.	鮑興, 都敏, 戴璟瑜, 等.胃旁路術對2型糖尿病大鼠的降糖作用及胰高血糖素樣肽-1的影響.中華實驗外科雜志, 2013, 30(1):36-38.
9.	鄒洪, 閆洪濤, 伍松, 等.回腸轉位術對自發性糖尿病大鼠肝臟脂代謝的影響及其意義.第三軍醫大學學報, 2012, 34(11):1114-1116.
10.	蔡遜, 葉家欣, 馬丹丹, 等. RYGBP與BPD對2型糖尿病大鼠的血糖控制及GLP-1表達的影響.華南國防醫學雜志, 2013, 27(8):540-543.
11.	American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care, 2010, 33 Suppl 1:S11-S61.
12.	Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery:an IDF statement for obese type 2 diabetes. Diabet Med, 2011, 28(6):628-642.
13.	中華醫學會糖尿病學分會.中國2型糖尿病防治指南(2010年版).中國糖尿病雜志, 2011, 20(1):5.
14.	鄧治洲, 王烈, 林憶陽, 等.胃轉流術對非肥胖型2型糖尿病的療效觀察及其對胰高血糖素樣肽-1的影響.中國普外基礎與臨床雜志, 2009, 16(6):466-469.
15.	Celik A, Ugale S, Ofluoglu H, et al. Metabolic outcomes of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) in obese type 2 diabetic patients. Obes Surg, 2015, 25(11):2018-2022.
16.	Ersoz F, Duzkoylu Y, Deniz MM, et al. Laparoscopic Roux-en-Y gastric bypass with ileal transposition-an alternative surgical treatment for type 2 diabetes mellitus and gastroesophageal reflux. Wideochir Inne Tech Maloinwazyjne, 2015, 10(3):481-485.
17.	Patriti A, Facchiano E, Annetti C, et al. Early improvement of glucose tolerance after ileal transposition in a non-obese type 2 diabetes rat model. Obes Surg, 2005, 15(9):1258-1264.
18.	許廣松, 吳江, 秦春宏, 等.回腸轉位術對GK大鼠血糖及GLP-1分泌影響的研究.中國糖尿病雜志, 2013, 21(11):1041-1045.
19.	MacDonald PE, El-Kholy W, Riedel MJ, et al. The multiple actions of GLP-1 on the process of glucose-stimulated insulin secretion. Diabetes, 2002, 51 Suppl 3:S434-S442.
20.	陳博, 伍曉汀. 2型糖尿病手術干預機理及其研究進展.中國普外基礎與臨床雜志, 2012, 19(12):1283-1285.
21.	Chelikani PK, Shah IH, Taqi E, et al. Comparison of the effects of Roux-en-Y gastric bypass and ileal transposition surgeries on food intake, body weight, and circulating peptide YY concentrations in rats. Obes Surg, 2010, 20(9):1281-1288.
22.	Buchwald H, Dorman RB, Rasmus NF, et al. Effects on GLP-1, PYY, and leptin by direct stimulation of terminal ileum and cecum in humans:implications for ileal transposition. Surg Obes Relat Dis, 2014, 10(5):780-786.
23.	Ballantyne GH, Gumbs A, Modlin IM. Changes in insulin resistance following bariatric surgery and the adipoinsular axis:role of the adipocytokines, leptin, adiponectin and resistin. Obes Surg, 2005, 15(5):692-699.
24.	Zhang L, Wang Y, Wang J, et al. Protein kinase C pathway mediates the protective effects of glucagon-like peptide-1 on the apoptosis of islet β-cells. Mol Med Rep, 2015, 12(5):7589-7594.
25.	Ritz P, Vaurs C, Barigou M, et al. Hypoglycaemia after gastric bypass:mechanisms and treatment. Diabetes Obes Metab, 2016, 18(3):217-223.

1. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes:estimates for the year 2000 and projections for 2030. Diabetes Care, 2004, 27(5):1047-1053.
2. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會.中國肥胖和2型糖尿病外科治療指南(2014).中國實用外科雜志, 2014, 34(11):1005-1010.
3. Detournay B, Cros S, Charbonnel B, et al. Managing type 2 diabetes in France:the ECODIA survey. Diabetes Metab, 2000, 26(5):363-369.
4. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg, 1995, 222(3):339-352.
5. Wang TT, Hu SY, Gao HD, et al. Ileal transposition controls diabetes as well as modified duodenal jejunal bypass with better lipid lowering in a nonobese rat model of type Ⅱ diabetes by increasing GLP-1. Ann Surg, 2008, 247(6):968-975.
6. Depaula AL, Macedo AL, Mota BR, et al. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21-29. Surg Endosc, 2009, 23(6):1313-1320.
7. 田曉豐, 曹宏, 陳丹磊, 等.胃旁路術對非肥胖2型糖尿病大鼠降血糖作用機制的初步研究.中國實驗診斷學, 2010, 14(6):833-835.
8. 鮑興, 都敏, 戴璟瑜, 等.胃旁路術對2型糖尿病大鼠的降糖作用及胰高血糖素樣肽-1的影響.中華實驗外科雜志, 2013, 30(1):36-38.
9. 鄒洪, 閆洪濤, 伍松, 等.回腸轉位術對自發性糖尿病大鼠肝臟脂代謝的影響及其意義.第三軍醫大學學報, 2012, 34(11):1114-1116.
10. 蔡遜, 葉家欣, 馬丹丹, 等. RYGBP與BPD對2型糖尿病大鼠的血糖控制及GLP-1表達的影響.華南國防醫學雜志, 2013, 27(8):540-543.
11. American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care, 2010, 33 Suppl 1:S11-S61.
12. Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery:an IDF statement for obese type 2 diabetes. Diabet Med, 2011, 28(6):628-642.
13. 中華醫學會糖尿病學分會.中國2型糖尿病防治指南(2010年版).中國糖尿病雜志, 2011, 20(1):5.
14. 鄧治洲, 王烈, 林憶陽, 等.胃轉流術對非肥胖型2型糖尿病的療效觀察及其對胰高血糖素樣肽-1的影響.中國普外基礎與臨床雜志, 2009, 16(6):466-469.
15. Celik A, Ugale S, Ofluoglu H, et al. Metabolic outcomes of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) in obese type 2 diabetic patients. Obes Surg, 2015, 25(11):2018-2022.
16. Ersoz F, Duzkoylu Y, Deniz MM, et al. Laparoscopic Roux-en-Y gastric bypass with ileal transposition-an alternative surgical treatment for type 2 diabetes mellitus and gastroesophageal reflux. Wideochir Inne Tech Maloinwazyjne, 2015, 10(3):481-485.
17. Patriti A, Facchiano E, Annetti C, et al. Early improvement of glucose tolerance after ileal transposition in a non-obese type 2 diabetes rat model. Obes Surg, 2005, 15(9):1258-1264.
18. 許廣松, 吳江, 秦春宏, 等.回腸轉位術對GK大鼠血糖及GLP-1分泌影響的研究.中國糖尿病雜志, 2013, 21(11):1041-1045.
19. MacDonald PE, El-Kholy W, Riedel MJ, et al. The multiple actions of GLP-1 on the process of glucose-stimulated insulin secretion. Diabetes, 2002, 51 Suppl 3:S434-S442.
20. 陳博, 伍曉汀. 2型糖尿病手術干預機理及其研究進展.中國普外基礎與臨床雜志, 2012, 19(12):1283-1285.
21. Chelikani PK, Shah IH, Taqi E, et al. Comparison of the effects of Roux-en-Y gastric bypass and ileal transposition surgeries on food intake, body weight, and circulating peptide YY concentrations in rats. Obes Surg, 2010, 20(9):1281-1288.
22. Buchwald H, Dorman RB, Rasmus NF, et al. Effects on GLP-1, PYY, and leptin by direct stimulation of terminal ileum and cecum in humans:implications for ileal transposition. Surg Obes Relat Dis, 2014, 10(5):780-786.
23. Ballantyne GH, Gumbs A, Modlin IM. Changes in insulin resistance following bariatric surgery and the adipoinsular axis:role of the adipocytokines, leptin, adiponectin and resistin. Obes Surg, 2005, 15(5):692-699.
24. Zhang L, Wang Y, Wang J, et al. Protein kinase C pathway mediates the protective effects of glucagon-like peptide-1 on the apoptosis of islet β-cells. Mol Med Rep, 2015, 12(5):7589-7594.
25. Ritz P, Vaurs C, Barigou M, et al. Hypoglycaemia after gastric bypass:mechanisms and treatment. Diabetes Obes Metab, 2016, 18(3):217-223.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Ileal Transposition and Roux-en-Y Gastric Bypass on Blood Glucose and Expression of GLP-1 in Rats with Non-Obese Type 2 Diabetes Mellitus

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