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

AimsTo 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. MethodsSixteen patients with Type 2 diabetes and BMI <36kg/m(2) were evaluated before and 1, 12 and 52weeks after duodenal-jejunal bypass liner implantation and 26weeks after explantation. Mixed-meal tolerance tests were conducted over a period of 120min 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. ResultsBody weight decreased by 1.3kg after 1week and by 2.4kg after 52weeks (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 1week 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 26weeks 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. ConclusionsThe 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.