Comparison of effects of sleeve gastrectomy, duodenal-jejunal bypass and ileal transposition for type II diabetes

Abstract

INTRODUCTION: Sleeve gastrectomy (SG), duodenal jejuna bypass (DJB) and ileal transposition (IT) have been reported to be effective for the treatment of T2DM. OBJECTIVES: It is unknown which procedure has a stronger anti-diabetic effect. The purpose of this study was to compare the effectiveness of these novel procedures METHODS: SG, DJB, IT and sham operation of each procedure were performed in 10-12 weeks old Goto-Kakizaki rats, a spontaneous non-obese model of T2DM. The glucose homeostasis effect was evaluated by measuring fasting glucose (FBG) and glycosylated haemoglobin (HbA1c). Gut hormonal profiles and lipid absorption were also examined. Rats were observed for 1 year. RESULTS: All three procedures had significant lower FBG when compared to the respective sham groups. DJB and IT had lower FBG than SG (SG vs DJB, p=0.023; SG vs IT, p=0.009) whereas DJB and IT had a similar FBG level, p=0.678. For HbA1c, all procedures had lower levels than the respective sham groups, p<0.001. The HbA1c of SG rebounded on 8th week whereas HbA1c of DJB and IT remained at low level. SG had a significant higher HbA1c level than DJB and IT, p<0.001 while DJB and IT had a similar level, p=0.685. GLP-1 and PYY were raised in DJB and IT whereas GIP level increased in DJB. All three procedures have different lipid absorption profile. CONCLUSION: SG, DJB and IT all had anti-diabetic effect. DJB and IT had more potent anti-diabetic effect than SG. Each procedure has different effects on metabolic diseases and their clinic application deserve individual consideration.