近端肠道对食物的排除作用在 2 型糖尿病患者糖代谢稳态中的作用。

Role of proximal gut exclusion from food on glucose homeostasis in patients with Type 2 diabetes.

机构信息

Center of Excellence for the Surgical Treatment of Morbid Obesity, Hospital Oswaldo Cruz, São Paulo, São Paulo, Brazil.

出版信息

Diabet Med. 2013 Dec;30(12):1482-6. doi: 10.1111/dme.12268. Epub 2013 Jul 19.

DOI:10.1111/dme.12268

PMID:23802863

Abstract

AIMS

To report Type 2 diabetes-related outcomes after the implantation of a duodenal-jejunal bypass liner device and to investigate the role of proximal gut exclusion from food in glucose homeostasis using the model of this device.

METHODS

Sixteen patients with Type 2 diabetes and BMI <36 kg/m(2) were evaluated before and 1, 12 and 52 weeks after duodenal-jejunal bypass liner implantation and 26 weeks after explantation. Mixed-meal tolerance tests were conducted over a period of 120 min and glucose, insulin and C-peptide levels were measured. The Matsuda index and the homeostatic model of assessment of insulin resistance were used for the estimation of insulin sensitivity and insulin resistance. The insulin secretion rate was calculated using deconvolution of C-peptide levels.

RESULTS

Body weight decreased by 1.3 kg after 1 week and by 2.4 kg after 52 weeks (P < 0.001). One year after duodenal-jejunal bypass liner implantation, the mean (sem) HbA(1c) level decreased from 71.3 (2.4) mmol/mol (8.6[0.2]%) to 58.1 (4.4) mmol/mol (7.5 [0.4]%) and mean (sem) fasting glucose levels decreased from 203.3 (13.5) mg/dl to 155.1 (13.1) mg/dl (both P < 0.001). Insulin sensitivity improved by >50% as early as 1 week after implantation as measured by the Matsuda index and the homeostatic model of assessment of insulin resistance (P < 0.001), but there was a trend towards deterioration in all the above-mentioned variables 26 weeks after explantation. Fasting insulin levels, insulin area under the curve, fasting C-peptide, C-peptide area under the curve, fasting insulin and total insulin secretion rates did not change during the duodenal-jejunal bypass liner implantation period or after explantation.

CONCLUSIONS

The duodenal-jejunal bypass liner improves glycaemia in overweight and obese patients with Type 2 diabetes by rapidly improving insulin sensitivity. A reduction in hepatic glucose output is the most likely explanation for this improvement.

摘要

目的

报告十二指肠-空肠旁路管装置植入后与 2 型糖尿病相关的结果，并利用该装置模型研究近端肠道排除食物对葡萄糖稳态的作用。

方法

16 例 2 型糖尿病合并 BMI<36kg/m²的患者，在十二指肠-空肠旁路管装置植入前及植入后 1、12、52 周和取出后 26 周进行评估。120min 内进行混合餐耐量试验，测量血糖、胰岛素和 C 肽水平。使用 Matsuda 指数和稳态模型评估胰岛素抵抗来评估胰岛素敏感性和胰岛素抵抗。使用 C 肽水平的反卷积计算胰岛素分泌率。

结果

体重在 1 周后下降 1.3kg，52 周后下降 2.4kg（P<0.001）。十二指肠-空肠旁路管装置植入 1 年后，HbA1c 水平从 71.3（2.4）mmol/mol（8.6[0.2]%）降至 58.1（4.4）mmol/mol（7.5[0.4]%），空腹血糖水平从 203.3（13.5）mg/dl 降至 155.1（13.1）mg/dl（均 P<0.001）。Matsuda 指数和稳态模型评估胰岛素抵抗评估的胰岛素敏感性改善了>50%，早在植入后 1 周即可观察到（P<0.001），但在取出后 26 周时所有上述变量均呈恶化趋势。植入期间及取出后，空腹胰岛素水平、胰岛素曲线下面积、空腹 C 肽、C 肽曲线下面积、空腹胰岛素和总胰岛素分泌率均无变化。