Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, 3801 University Street, Montreal, QC H3A 2B4, Canada.
Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada; Department of Medicine, Division of Endocrinology, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Québec, Canada.
Metabolism. 2017 Sep;74:10-21. doi: 10.1016/j.metabol.2017.06.005. Epub 2017 Jun 21.
The aim of this study was to compare the short-term effect of sleeve gastrectomy (SG) and biliopancreatic diversion with duodenal switch (DS) in order to determine if exclusion of the upper gastrointestinal tract confers greater metabolic improvement, independent of weight loss.
Standard meals were administered before and on day 3 and 4 after SG to assess insulin sensitivity, β-cell function and gastrointestinal hormone responses in matched normoglycemic (NG) and type 2 diabetes (T2D) participants. A third group of matched T2D participants who underwent DS with the same meal test administered prior to and 3days after surgery was also recruited.
Despite significant metabolic improvement, T2D participants failed to fully normalize insulin resistance and β-cell dysfunction 3 and 4days after SG. Our results demonstrate the superiority of DS over SG in terms of short-term improvement in postprandial glucose excursion and β-cell function 3days after the surgery, with similar improvement in hepatic insulin sensitivity.
Our findings support the notion that caloric restriction represents an important mechanism to explain the very early anti-diabetic effects observed after bariatric surgery. However, exclusion of the upper gastrointestinal tract also provides further metabolic improvements, possibly mediated by gastrointestinal hormonal responses and altered postprandial glucose absorption.
本研究旨在比较袖状胃切除术（SG）和胆胰分流联合十二指肠转位术（DS）的短期效果，以确定上消化道的切除是否能在不依赖于体重减轻的情况下带来更大的代谢改善。
在匹配的血糖正常（NG）和 2 型糖尿病（T2D）参与者中，在 SG 前和第 3 天及第 4 天给予标准餐，以评估胰岛素敏感性、β细胞功能和胃肠激素反应。还招募了第三组匹配的 T2D 参与者，他们在接受 DS 手术前和手术后 3 天进行了相同的餐食测试。
尽管代谢改善显著，但 T2D 参与者在 SG 后第 3 天和第 4 天仍未能完全正常化胰岛素抵抗和β细胞功能。我们的结果表明，DS 在术后 3 天改善餐后血糖波动和β细胞功能方面优于 SG，而肝胰岛素敏感性也有类似的改善。
我们的发现支持这样一种观点，即热量限制是解释肥胖症手术后早期抗糖尿病作用的一个重要机制。然而，上消化道的切除也提供了进一步的代谢改善，可能是通过胃肠激素反应和改变餐后葡萄糖吸收来介导的。
