Observation of Curative Effect of Gastric Bypass Operation on Non-Obese Type 2 Diabetes and Change of Glucagon-Like Peptide-1_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DENG Zhizhou ¹ , WANG Lie ¹ , LIN Yiyang ² , WANG Yu ¹

1.Department of General Surgery, Fuzong Medical College, Fujian Medical University (Fuzhou General Hospital of Nanjing Military Command), Fuzhou 350025, China;;
2.Department of Endocrine, Fuzong Medical College, Fujian Medical University (Fuzhou General Hospital of Nanjing Military Command), Fuzhou 350025, China;

Corresponding author：

Keywords：

Gastric bypass operation; Type 2 diabetes; Non-obese; Glucagon-like peptide-1; Insulin; Plasma glucose

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Objective To observe the curative effect on non-obese type 2 diabetes and the effect on change of glucagon-like peptide-1 (GLP-1) of gastric bypass operation. Methods Thirty-two cases of gastric ulcer with non-obese type 2 diabetes were suffered gastric bypass operation. Plasma glucose concentrations, insulin and GLP-1 were measured respectively in fasting and postprandial conditions before operation and in week 1, 2, 3 and month 1, 3, 6 after gastric bypass operation, and the body mass index (BMI), homeostasis model assessment β cell function index (HBCI) and glycosylated hemoglobin (HbA1c， the index was detected only before operation and in month 3, 6 after operation) were also measured. The turnover of the diabetes condition in the 6th month after surgery was observed. Results Compared with the levels before operation, the fasting and postprandial plasma glucose levels were descending (P＜0.05), fasting and postprandial plasma insulin and GLP-1 levels were ascending (P＜0.05), HBCI was ascending and HbA1c was descending significantly after operation respectively (P＜0.05), while BMI changed un-significantly after operation (P gt;0.05). The diabetes control rate was 78.1%(25/32) overall six months after operation. Level of GLP-1 was negatively correlated with level of plasma glucose (P＜0.05) and positively correlated with level of insulin (P＜0.05). Conclusions Gastric bypass operation can markedly reduce plasma glucose level on the type 2 diabetes patients with non-obese, and the hypoglycemic effect may be contributed by more GLP-1 secretion that caused more insulin secretion, which doesn’t depend on the loss of weight.

Citation： DENG Zhizhou,WANG Lie,LIN Yiyang,WANG Yu. Observation of Curative Effect of Gastric Bypass Operation on Non-Obese Type 2 Diabetes and Change of Glucagon-Like Peptide-1. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(6): 466-469. doi: Copy

1.	Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030 [Ｊ]. Diabetes Care， 2004; 27(5): 1047-1053.
2.	Detournay B, Cros S, Charbonnel B, et al. Managing type 2 diabetes in France: the ECODIA survey [Ｊ]. Diabetes Metab, 2000; 26(5): 363-369.
3.	Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus [Ｊ]. Ann Surg, 2002; 236(5): 554-559.
4.	Greenway SE, Greenway FL 3rd, Klein S. Effects of obesity surgery on non-insulin-dependent diabetes mellitus [Ｊ]. Arch Surg, 2002; 137(10): 1109-1117.
5.	Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity [Ｊ]. Ann Surg, 2000; 232(4): 515-529.
6.	Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution [Ｊ]. J Clin Endocrinol Metab, 2004; 89(6): 2608-2615.
7.	Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus [Ｊ]. Ann Surg, 2003; 238(4): 467-484.
8.	Pories WJ. Diabetes: the evolution of a new paradigm [Ｊ]. Ann Surg, 2004; 239(1): 12-13.
9.	Ferchak CV, Meneghini LF. Obesity, bariatric surgery and type 2 diabetes-a systematic review [Ｊ]. Diabetes Metab Res Rev, 2004; 20(6): 438-445.
10.	王瑜，王燕婷，王烈. 胃转流术对非肥胖型2型糖尿病的治疗作用 [Ｊ]. 中国普通外科杂志， 2008； 17(10)： 1003-1006.
11.	张新国，杨学军，徐红，等. 手术治疗2型糖尿病——回顾性临床研究及近期临床试用报告 [Ｊ]. 中华临床医学实践杂志， 2005； 4(5)： 459-461.
12.	王湘辉，李涛，王海忠. Roux-en-Y胃转流术治疗Ⅱ型糖尿病 [Ｊ]. 西北国防医学杂志， 2006； 27(4)： 298-299.
13.	Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus [Ｊ]. Diabetes Care, 2003; 26 Suppl 1: S5-S20.
14.	黄从云，王建南，彭淑牖，等. 胃肠道浆肌层吻合、黏膜外吻合、一层吻合和二层吻合的实验比较研究 [Ｊ]. 中国普外基础与临床杂志， 2007； 14(4)： 432-436.
15.	张伟，赵高平，杨春，等. 胃肠道肿瘤合并糖尿病患者术后早期肠内营养支持及血糖控制 [Ｊ]. 中国普外基础与临床杂志， 2008； 15(6)： 444-447.
16.	Mottin CC, Vontobel Padoin A, Schroer CE, et al. Behavior of type 2 diabetes mellitus in morbid obese patients submitted to gastric bypass [Ｊ]. Obes Surg, 2008; 18(2): 179-181.
17.	Lee WJ, Wang W. Bariatric surgery: Asia-Pacific perspective [Ｊ]. Obes Surg, 2005; 15(6): 751-757.
18.	DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity [Ｊ]. Ann Surg, 2002; 235(5): 640-645.
19.	Ash S, Reeves MM, Yeo S, et al. Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type Ⅱ diabetes: a randomised trial [Ｊ]. Int J Obes Relat Metab Disord, 2003; 27(7): 797-802.
20.	White S, Brooks E, Jurikova L, et al. Long-term outcomes after gastric bypass [Ｊ]. Obes Surg, 2005; 15(2): 155-163.
21.	Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease [Ｊ]. Ann Surg, 2004; 239(1): 1-11.
22.	Patriti A, Facchiano E, Sanna A, et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery [Ｊ]. Obes Surg, 2004; 14(6): 840-848.
23.	Zander M, Madsbad S, Madsen JL, et al. Effect of 6-week course of glucagon-like peptide 1 on glycaemic control, insulin sensitivity, and beta-cell function in type 2 diabetes: a parallel-group study [Ｊ]. Lancet, 2002; 359(9309): 824-830.
24.	Egan JM, Meneilly GS, Elahi D. Effects of 1-mo bolus subcutaneous administration of exendin-4 in type 2 diabetes [Ｊ]. Am J Physiol Endocrinol Metab, 2003; 284(6): E1072-E1079.
25.	Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes [Ｊ]. J Clin Endocrinol Metab, 2008; 93(7): 2479-2485.
26.	Laferrère B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes [Ｊ]. Diabetes Care, 2007; 30(7): 1709-1716.

1. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030 [Ｊ]. Diabetes Care， 2004; 27(5): 1047-1053.
2. Detournay B, Cros S, Charbonnel B, et al. Managing type 2 diabetes in France: the ECODIA survey [Ｊ]. Diabetes Metab, 2000; 26(5): 363-369.
3. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus [Ｊ]. Ann Surg, 2002; 236(5): 554-559.
4. Greenway SE, Greenway FL 3rd, Klein S. Effects of obesity surgery on non-insulin-dependent diabetes mellitus [Ｊ]. Arch Surg, 2002; 137(10): 1109-1117.
5. Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity [Ｊ]. Ann Surg, 2000; 232(4): 515-529.
6. Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution [Ｊ]. J Clin Endocrinol Metab, 2004; 89(6): 2608-2615.
7. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus [Ｊ]. Ann Surg, 2003; 238(4): 467-484.
8. Pories WJ. Diabetes: the evolution of a new paradigm [Ｊ]. Ann Surg, 2004; 239(1): 12-13.
9. Ferchak CV, Meneghini LF. Obesity, bariatric surgery and type 2 diabetes-a systematic review [Ｊ]. Diabetes Metab Res Rev, 2004; 20(6): 438-445.
10. 王瑜，王燕婷，王烈. 胃转流术对非肥胖型2型糖尿病的治疗作用 [Ｊ]. 中国普通外科杂志， 2008； 17(10)： 1003-1006.
11. 张新国，杨学军，徐红，等. 手术治疗2型糖尿病——回顾性临床研究及近期临床试用报告 [Ｊ]. 中华临床医学实践杂志， 2005； 4(5)： 459-461.
12. 王湘辉，李涛，王海忠. Roux-en-Y胃转流术治疗Ⅱ型糖尿病 [Ｊ]. 西北国防医学杂志， 2006； 27(4)： 298-299.
13. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus [Ｊ]. Diabetes Care, 2003; 26 Suppl 1: S5-S20.
14. 黄从云，王建南，彭淑牖，等. 胃肠道浆肌层吻合、黏膜外吻合、一层吻合和二层吻合的实验比较研究 [Ｊ]. 中国普外基础与临床杂志， 2007； 14(4)： 432-436.
15. 张伟，赵高平，杨春，等. 胃肠道肿瘤合并糖尿病患者术后早期肠内营养支持及血糖控制 [Ｊ]. 中国普外基础与临床杂志， 2008； 15(6)： 444-447.
16. Mottin CC, Vontobel Padoin A, Schroer CE, et al. Behavior of type 2 diabetes mellitus in morbid obese patients submitted to gastric bypass [Ｊ]. Obes Surg, 2008; 18(2): 179-181.
17. Lee WJ, Wang W. Bariatric surgery: Asia-Pacific perspective [Ｊ]. Obes Surg, 2005; 15(6): 751-757.
18. DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity [Ｊ]. Ann Surg, 2002; 235(5): 640-645.
19. Ash S, Reeves MM, Yeo S, et al. Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type Ⅱ diabetes: a randomised trial [Ｊ]. Int J Obes Relat Metab Disord, 2003; 27(7): 797-802.
20. White S, Brooks E, Jurikova L, et al. Long-term outcomes after gastric bypass [Ｊ]. Obes Surg, 2005; 15(2): 155-163.
21. Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease [Ｊ]. Ann Surg, 2004; 239(1): 1-11.
22. Patriti A, Facchiano E, Sanna A, et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery [Ｊ]. Obes Surg, 2004; 14(6): 840-848.
23. Zander M, Madsbad S, Madsen JL, et al. Effect of 6-week course of glucagon-like peptide 1 on glycaemic control, insulin sensitivity, and beta-cell function in type 2 diabetes: a parallel-group study [Ｊ]. Lancet, 2002; 359(9309): 824-830.
24. Egan JM, Meneilly GS, Elahi D. Effects of 1-mo bolus subcutaneous administration of exendin-4 in type 2 diabetes [Ｊ]. Am J Physiol Endocrinol Metab, 2003; 284(6): E1072-E1079.
25. Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes [Ｊ]. J Clin Endocrinol Metab, 2008; 93(7): 2479-2485.
26. Laferrère B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes [Ｊ]. Diabetes Care, 2007; 30(7): 1709-1716.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Observation of Curative Effect of Gastric Bypass Operation on Non-Obese Type 2 Diabetes and Change of Glucagon-Like Peptide-1

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