Endoscopic Duodenal-Jejunal Bypass Liner Rapidly Improves Type 2 Diabetes

Charlotte de Jonge; Sander S. Rensen; Froukje J. Verdam; Royce Vincent; Steve R. Bloom; Wim A. Buurman; Carel W. le Roux; Nicolaas C. Schaper; Nicole D. Bouvy; Jan Willem M. Greve

doi:10.1007/s11695-013-0921-3

Endoscopic Duodenal-Jejunal Bypass Liner Rapidly Improves Type 2 Diabetes

Charlotte de Jonge, Sander S. Rensen, Froukje J. Verdam, Royce Vincent, Steve R. Bloom, Wim A. Buurman, Carel W. le Roux, Nicolaas C. Schaper, Nicole D. Bouvy, Jan Willem M. Greve^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

126 Citations (Scopus)

Abstract

Background
Bariatric procedures excluding the proximal small intestine improve glycemic control in type 2 diabetes within days. To gain insight into the mediators involved, we investigated factors regulating glucose homeostasis in patients with type 2 diabetes treated with the novel endoscopic duodenal-jejunal bypass liner (DJBL).

Methods
Seventeen obese patients (BMI 30-50 kg/m(2)) with type 2 diabetes received the DJBL for 24 weeks. Body weight and type 2 diabetes parameters, including HbA(1c) and plasma levels of glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon, were analyzed after a standard meal before, during, and 1 week after DJBL treatment.

Results
At 24 weeks after implantation, patients had lost 12.7 +/- 1.3 kg (p <0.01), while HbA(1c) had improved from 8.4 +/- 0.2 to 7.0 +/- 0.2 % (p <0.01). Both fasting glucose levels and the postprandial glucose response were decreased at 1 week after implantation and remained decreased at 24 weeks (baseline vs. week 1 vs. week 24: 11.6 +/- 0.5 vs. 9.0 +/- 0.5 vs. 8.6 +/- 0.5 mmol/L and 1,999 +/- 85 vs. 1,536 +/- 51 vs. 1,538 +/- 72 mmol/L/min, both p <0.01). In parallel, the glucagon response decreased (23,762 +/- 4,732 vs. 15,989 +/- 3,193 vs. 13,1207 +/- 1,946 pg/mL/min, p <0.05) and the GLP-1 response increased (4,440 +/- 249 vs. 6,407 +/- 480 vs. 6,008 +/- 429 pmol/L/min, p <0.01). The GIP response was decreased at week 24 (baseline-115,272 +/- 10,971 vs. week 24-88,499 +/- 10,971 pg/mL/min, p <0.05). Insulin levels did not change significantly. Glycemic control was still improved 1 week after explantation.

Conclusions
The data indicate DJBL to be a promising treatment for obesity and type 2 diabetes, causing rapid improvement of glycemic control paralleled by changes in gut hormones.

Original language	English
Pages (from-to)	1354-1360
Number of pages	7
Journal	OBESITY SURGERY
Volume	23
Issue number	9
DOIs	https://doi.org/10.1007/s11695-013-0921-3
Publication status	Published - Sept 2013

Keywords

Obesity
Type 2 diabetes
Gut hormones
GLP-1
GIP
Glucagon
BARIATRIC SURGERY
GLUCAGON-SECRETION
WEIGHT-LOSS
GLYCEMIC CONTROL
GASTRIC BYPASS
INSULIN
MELLITUS
REMISSION
PEPTIDE-1
INCRETIN

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s11695-013-0921-3

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@article{b81ef6b905c241fda559d6bfc97647c4,

title = "Endoscopic Duodenal-Jejunal Bypass Liner Rapidly Improves Type 2 Diabetes",

abstract = "Background Bariatric procedures excluding the proximal small intestine improve glycemic control in type 2 diabetes within days. To gain insight into the mediators involved, we investigated factors regulating glucose homeostasis in patients with type 2 diabetes treated with the novel endoscopic duodenal-jejunal bypass liner (DJBL). Methods Seventeen obese patients (BMI 30-50 kg/m(2)) with type 2 diabetes received the DJBL for 24 weeks. Body weight and type 2 diabetes parameters, including HbA(1c) and plasma levels of glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon, were analyzed after a standard meal before, during, and 1 week after DJBL treatment. Results At 24 weeks after implantation, patients had lost 12.7 +/- 1.3 kg (p <0.01), while HbA(1c) had improved from 8.4 +/- 0.2 to 7.0 +/- 0.2 % (p <0.01). Both fasting glucose levels and the postprandial glucose response were decreased at 1 week after implantation and remained decreased at 24 weeks (baseline vs. week 1 vs. week 24: 11.6 +/- 0.5 vs. 9.0 +/- 0.5 vs. 8.6 +/- 0.5 mmol/L and 1,999 +/- 85 vs. 1,536 +/- 51 vs. 1,538 +/- 72 mmol/L/min, both p <0.01). In parallel, the glucagon response decreased (23,762 +/- 4,732 vs. 15,989 +/- 3,193 vs. 13,1207 +/- 1,946 pg/mL/min, p <0.05) and the GLP-1 response increased (4,440 +/- 249 vs. 6,407 +/- 480 vs. 6,008 +/- 429 pmol/L/min, p <0.01). The GIP response was decreased at week 24 (baseline-115,272 +/- 10,971 vs. week 24-88,499 +/- 10,971 pg/mL/min, p <0.05). Insulin levels did not change significantly. Glycemic control was still improved 1 week after explantation. Conclusions The data indicate DJBL to be a promising treatment for obesity and type 2 diabetes, causing rapid improvement of glycemic control paralleled by changes in gut hormones.",

keywords = "Obesity, Type 2 diabetes, Gut hormones, GLP-1, GIP, Glucagon, BARIATRIC SURGERY, GLUCAGON-SECRETION, WEIGHT-LOSS, GLYCEMIC CONTROL, GASTRIC BYPASS, INSULIN, MELLITUS, REMISSION, PEPTIDE-1, INCRETIN",

author = "{de Jonge}, Charlotte and Rensen, {Sander S.} and Verdam, {Froukje J.} and Royce Vincent and Bloom, {Steve R.} and Buurman, {Wim A.} and {le Roux}, {Carel W.} and Schaper, {Nicolaas C.} and Bouvy, {Nicole D.} and Greve, {Jan Willem M.}",

year = "2013",

month = sep,

doi = "10.1007/s11695-013-0921-3",

language = "English",

volume = "23",

pages = "1354--1360",

journal = "OBESITY SURGERY",

issn = "0960-8923",

publisher = "Springer",

number = "9",

}

TY - JOUR

T1 - Endoscopic Duodenal-Jejunal Bypass Liner Rapidly Improves Type 2 Diabetes

AU - de Jonge, Charlotte

AU - Rensen, Sander S.

AU - Verdam, Froukje J.

AU - Vincent, Royce

AU - Bloom, Steve R.

AU - Buurman, Wim A.

AU - le Roux, Carel W.

AU - Schaper, Nicolaas C.

AU - Bouvy, Nicole D.

AU - Greve, Jan Willem M.

PY - 2013/9

Y1 - 2013/9

N2 - Background Bariatric procedures excluding the proximal small intestine improve glycemic control in type 2 diabetes within days. To gain insight into the mediators involved, we investigated factors regulating glucose homeostasis in patients with type 2 diabetes treated with the novel endoscopic duodenal-jejunal bypass liner (DJBL). Methods Seventeen obese patients (BMI 30-50 kg/m(2)) with type 2 diabetes received the DJBL for 24 weeks. Body weight and type 2 diabetes parameters, including HbA(1c) and plasma levels of glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon, were analyzed after a standard meal before, during, and 1 week after DJBL treatment. Results At 24 weeks after implantation, patients had lost 12.7 +/- 1.3 kg (p <0.01), while HbA(1c) had improved from 8.4 +/- 0.2 to 7.0 +/- 0.2 % (p <0.01). Both fasting glucose levels and the postprandial glucose response were decreased at 1 week after implantation and remained decreased at 24 weeks (baseline vs. week 1 vs. week 24: 11.6 +/- 0.5 vs. 9.0 +/- 0.5 vs. 8.6 +/- 0.5 mmol/L and 1,999 +/- 85 vs. 1,536 +/- 51 vs. 1,538 +/- 72 mmol/L/min, both p <0.01). In parallel, the glucagon response decreased (23,762 +/- 4,732 vs. 15,989 +/- 3,193 vs. 13,1207 +/- 1,946 pg/mL/min, p <0.05) and the GLP-1 response increased (4,440 +/- 249 vs. 6,407 +/- 480 vs. 6,008 +/- 429 pmol/L/min, p <0.01). The GIP response was decreased at week 24 (baseline-115,272 +/- 10,971 vs. week 24-88,499 +/- 10,971 pg/mL/min, p <0.05). Insulin levels did not change significantly. Glycemic control was still improved 1 week after explantation. Conclusions The data indicate DJBL to be a promising treatment for obesity and type 2 diabetes, causing rapid improvement of glycemic control paralleled by changes in gut hormones.

AB - Background Bariatric procedures excluding the proximal small intestine improve glycemic control in type 2 diabetes within days. To gain insight into the mediators involved, we investigated factors regulating glucose homeostasis in patients with type 2 diabetes treated with the novel endoscopic duodenal-jejunal bypass liner (DJBL). Methods Seventeen obese patients (BMI 30-50 kg/m(2)) with type 2 diabetes received the DJBL for 24 weeks. Body weight and type 2 diabetes parameters, including HbA(1c) and plasma levels of glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon, were analyzed after a standard meal before, during, and 1 week after DJBL treatment. Results At 24 weeks after implantation, patients had lost 12.7 +/- 1.3 kg (p <0.01), while HbA(1c) had improved from 8.4 +/- 0.2 to 7.0 +/- 0.2 % (p <0.01). Both fasting glucose levels and the postprandial glucose response were decreased at 1 week after implantation and remained decreased at 24 weeks (baseline vs. week 1 vs. week 24: 11.6 +/- 0.5 vs. 9.0 +/- 0.5 vs. 8.6 +/- 0.5 mmol/L and 1,999 +/- 85 vs. 1,536 +/- 51 vs. 1,538 +/- 72 mmol/L/min, both p <0.01). In parallel, the glucagon response decreased (23,762 +/- 4,732 vs. 15,989 +/- 3,193 vs. 13,1207 +/- 1,946 pg/mL/min, p <0.05) and the GLP-1 response increased (4,440 +/- 249 vs. 6,407 +/- 480 vs. 6,008 +/- 429 pmol/L/min, p <0.01). The GIP response was decreased at week 24 (baseline-115,272 +/- 10,971 vs. week 24-88,499 +/- 10,971 pg/mL/min, p <0.05). Insulin levels did not change significantly. Glycemic control was still improved 1 week after explantation. Conclusions The data indicate DJBL to be a promising treatment for obesity and type 2 diabetes, causing rapid improvement of glycemic control paralleled by changes in gut hormones.

KW - Obesity

KW - Type 2 diabetes

KW - Gut hormones

KW - GLP-1

KW - GIP

KW - Glucagon

KW - BARIATRIC SURGERY

KW - GLUCAGON-SECRETION

KW - WEIGHT-LOSS

KW - GLYCEMIC CONTROL

KW - GASTRIC BYPASS

KW - INSULIN

KW - MELLITUS

KW - REMISSION

KW - PEPTIDE-1

KW - INCRETIN

U2 - 10.1007/s11695-013-0921-3

DO - 10.1007/s11695-013-0921-3

M3 - Article

SN - 0960-8923

VL - 23

SP - 1354

EP - 1360

JO - OBESITY SURGERY

JF - OBESITY SURGERY

IS - 9

ER -

Endoscopic Duodenal-Jejunal Bypass Liner Rapidly Improves Type 2 Diabetes

Abstract

Keywords

UN SDGs

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