Patriti Alberto, Facchiano Enrico, Annetti Claudia, Aisa Maria Cristina, Galli Francesco, Fanelli Carmine, Donini Annibale
Department of Surgery, Section of General and Emergency Surgery, University of Perugia, Perugia, Italy.
Obes Surg. 2005 Oct;15(9):1258-64. doi: 10.1381/096089205774512573.
Surgical operations which shorten the intestinal tract between the stomach and the terminal ileum result in an early improvement in type 2 diabetes, and one possible explanation is the arrival of undigested food in the terminal ileum. This study was designed to evaluate the role of the distal ileum in the improvement of glucose control in type 2 diabetic patients who underwent bariatric surgery.
An ileal transposition (IT) to the jejunum was performed in lean diabetic Goto-Kakizaki (GK) rats. The IT was compared to sham-operated diabetic rats and a control group of diabetic rats. Non-diabetic controls were age-matched Sprague-Dawley (SD) rats, which underwent IT and no operation. Food intake and body weight were measured. An oral glucose tolerance test (OGTT) was performed 10 days before the operation and 10 days, 30 days and 45 days after the surgery. GLP-1 and insulin were measured during the OGTT 45 days after surgery. An insulin tolerance test (ITT) was performed 50 days after surgery.
Glucose tolerance improved in the IT diabetic group compared with both the sham-operated animals and control diabetic group 30 days and 45 days after surgery (P=0.029 and P=0.023, respectively). Insulin sensitivity, as measured by an ITT, was not significantly different between diabetic groups and the normal groups respectively after surgery. No differences in basal glucose and glucose tolerance were noted between non-diabetic operated animals and control non-diabetic rats. No differences were recorded between the diabetic rat groups and the non-diabetic rats in terms of weight and food intake. GLP-1 levels were significantly higher in the IT diabetic group compared with the sham-operated rats (P=0.05).
Ileal transposition is effective in inducing an improvement in glucose tolerance in lean diabetic rats without affecting weight and food intake. The possible mechanism underlying the early improvement of diabetes after bariatric surgery may be due to the action of the terminal ileum through an insulin-independent action.
缩短胃与回肠末端之间肠道的外科手术可使2型糖尿病早期得到改善，一种可能的解释是未消化食物抵达回肠末端。本研究旨在评估远端回肠在接受减重手术的2型糖尿病患者血糖控制改善中的作用。
对瘦型糖尿病Goto-Kakizaki（GK）大鼠进行回肠转位至空肠手术。将回肠转位组与假手术糖尿病大鼠及糖尿病大鼠对照组进行比较。非糖尿病对照组为年龄匹配的Sprague-Dawley（SD）大鼠，其接受回肠转位手术或未手术。测量食物摄入量和体重。在手术前10天以及手术后10天、30天和45天进行口服葡萄糖耐量试验（OGTT）。在手术后45天的OGTT期间测量胰高血糖素样肽-1（GLP-1）和胰岛素。在手术后50天进行胰岛素耐量试验（ITT）。
与假手术动物和糖尿病对照组相比，回肠转位糖尿病组在手术后30天和45天葡萄糖耐量得到改善（分别为P = 0.029和P = 0.023）。通过ITT测量，糖尿病组与正常组术后胰岛素敏感性无显著差异。非糖尿病手术动物与对照非糖尿病大鼠之间基础血糖和葡萄糖耐量无差异。糖尿病大鼠组与非糖尿病大鼠在体重和食物摄入量方面无差异。与假手术大鼠相比，回肠转位糖尿病组GLP-1水平显著更高（P = 0.05）。
回肠转位可有效改善瘦型糖尿病大鼠的葡萄糖耐量，且不影响体重和食物摄入量。减重手术后糖尿病早期改善的潜在机制可能是由于远端回肠通过非胰岛素依赖作用发挥功效。
