Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA.
Obesity (Silver Spring). 2012 Jun;20(6):1266-72. doi: 10.1038/oby.2011.377. Epub 2012 Jan 19.
Gastric bypass surgery causes resolution of type 2 diabetes (T2DM), which has led to the hypothesis that upper gastrointestinal (UGI) tract diversion, itself, improves glycemic control. The purpose of this study was to determine whether UGI tract bypass without gastric exclusion has therapeutic effects in patients with T2DM. We performed a prospective trial to assess glucose and β-cell response to an oral glucose load before and at 6, 9, and 12 months after duodenal-jejunal bypass (DJB) surgery. Thirty-five overweight or obese adults (BMI: 27.0 ± 4.0 kg/m(2)) with T2DM and 35 sex-, age-, race-, and BMI-matched subjects with normal glucose tolerance (NGT) were studied. Subjects lost weight after surgery, which was greatest at 3 months (6.9 ± 4.9%) with subsequent regain to 4.2 ± 5.3% weight loss at 12 months after surgery. Glycated hemoglobin (HbA(1c)) decreased from 9.3 ± 1.6% before to 7.7 ± 2.0% at 12 months after surgery (P < 0.001), in conjunction with a 20% decrease in the use of diabetes medications (P < 0.05); 7 (20%) subjects achieved remission of diabetes (no medications and HbA(1c) <6.5%). The area under the curve after glucose ingestion was ~20% lower for glucose but doubled for insulin and C-peptide at 12 months, compared with pre-surgery values (all P < 0.01). However, the β-cell response was still 70% lower than subjects with NGT (P < 0.001). DJB surgery improves glycemic control and increases, but does not normalize the β-cell response to glucose ingestion. These findings suggest that altering the intestinal site of delivery of ingested nutrients has moderate therapeutic effects by improving β-cell function and glycemic control.
胃旁路手术可治疗 2 型糖尿病（T2DM），这导致了一种假设，即上消化道（UGI）分流本身可以改善血糖控制。本研究的目的是确定十二指肠-空肠旁路（DJB）手术是否对 T2DM 患者的 UGI 旁路而不排除胃具有治疗作用。我们进行了一项前瞻性试验，以评估 T2DM 患者在 DJB 手术后 6、9 和 12 个月时口服葡萄糖负荷前后的血糖和β细胞反应。研究了 35 名超重或肥胖（BMI：27.0 ± 4.0 kg/m2）的 T2DM 患者和 35 名性别、年龄、种族和 BMI 匹配的糖耐量正常（NGT）受试者。手术后受试者体重减轻，术后 3 个月时体重减轻最大（6.9 ± 4.9%），随后在手术后 12 个月时体重恢复至 4.2 ± 5.3%的体重减轻。糖化血红蛋白（HbA1c）从术前的 9.3 ± 1.6%降至术后 12 个月的 7.7 ± 2.0%（P <0.001），同时糖尿病药物的使用减少了 20%（P <0.05）；7 名（20%）患者糖尿病缓解（无需药物且 HbA1c <6.5%）。与术前值相比，术后 12 个月时葡萄糖摄入后的曲线下面积（AUC）降低了约 20%，但胰岛素和 C 肽的 AUC 增加了一倍（均 P <0.01）。然而，β细胞反应仍比 NGT 受试者低 70%（P <0.001）。DJB 手术可改善血糖控制，并增加但不能使葡萄糖摄入后的β细胞反应正常化。这些发现表明，改变摄入营养物质的肠道输送部位通过改善β细胞功能和血糖控制具有适度的治疗作用。
