Comparative Study Of The Influence On Blood Glucose And Gut Hormone Between DJB, GBP And SG In GK Diabetic Rats

Objective:Five procedures were conducted for non-obese diabetic Goto-Kakizaki(GK) rats in our study, including duodenal-jejunal bypass(DJB), gastric bypass surgery(GBP), sleeve gastrectomy(SG), sham operation and control. To observe the influence of different procedures on intestinal hormones and glucose metabolic, and e xplore the role of the gastrointestinal tract on the improvement of glucose metabolic.To research the following questions:(1) Which surgical procedures can regulate blood sugar quickly and maintain a relatively stable blood sugar, DJB or SG, which represent intestinal and gastric change separately.(2) The effect of quick entrence into intestinal of food and reducing volume of stomach on the improvement of type II diabetes, and analysis the influence of foregut and hindgut on the improvement of type II diabetes.(3) The short and long term efficacy of three procedures(DJB, RYGB and SG) on glucose metabolic, insulin resistance and insulin sensitivity. Methods:50 10-12-week-old SPF male GK rats were chosen for our experiment, weight 220-260 g. They were divided into five groups, each 10, A group: DJB, B group: GBP, C group: SG, D group: sham group, E group: control group. Main outcome measures were body weight, fasting blood glucose(FBG), HOMA-IR at baseline and 1, 2, 4, 8, 12 weeks after procedures; food intake, oral glucose tolerance test(O GTT), insulin tolerance test(ITT) at baseline and 2, 12 weeks after procedures; glucagon-like peptide-1(GLP-1), glucose-dependent insulinotropic peptide(GIP), PeptideYY(PYY) and ghrenlin at baseline and 2, 12 weeks after procedures. We compared the change of glucose and intestinal hormones through DJB, GBP and SG in our study, and a nalyze the role of gastrointestinal factors on improvement of glucose metabolic caused by bariatric surgery. Results:GK rats survival rate: a rat died of severe infection caused by gastrointestinal anastomotic leak in GBP group.Body weight and food intake: In one week, the body weight of rats in each group were decreased. After one week, the body weight of rats in each group were increased. The total body weight in DJB group was higher than in GBP and SG group 8 weeks after surgery(P<0.05). The total body weight in GBP and SG group was lower than in DJB, Sham and Control group 12 weeks after surgery(P<0.05). The total food intake in each surgerical group was lower than in control group 12 weeks after surgery(P<0.05).Blood glucose, glucose tolerance: DJB and GBP both improve glucose tolerance at postoperative 1 or 2 week(P<0.05). The fasting blood glucose in DJB, GBP and SG group was lower than in Sham and Control group 12 weeks after surgery(P <0.05). The AUCOGTT of DJB, SG and GBP decreased significantly than Sham and Control group 12 weeks after surgery(P<0.05).HOMA-IR and ITT: The HOMA-IR in DJB and GBP group was improved significantly at 1 week(P<0.05), and the improvement accured at 4 weeks after surgery in sleeve group(P<0.05). There is no significant differences among DJB, GBP and SG group at postoperative 8 and 12 week(P>0.05). The AUCITT of DJB and GBP decreased significantly at postoperative 2 week(P<0.05). The AUCITT of DJB, SG and GBP decreased significantly at postoperative 12 week(P<0.05).Intestinal hormones(GLP-1, PYY, GIP, Ghrelin and bile acid): The 30 min post-prandial GLP-1, PYY, bile acid in DJB, SG and GBP were higher than any other group(P<0.05). There was no significant difference between DJB, GBP, SG, Sham and control groups on the 30 min post-prandial GIP. The 30 min post-prandial Ghrelin was lower in DJB, Sham and control groups than any other group(P<0.05). Conclusion:SG and GBP had achieved significant weight loss effects, and the total body weight increased significantly at postoperative 8 week, which shows that changes of gastric volume have a very important role in achieving great weight loss.There is an early decrease in the level of blood glucose in DJB and GBP, otherwise, the improvement of blood glucose did not decreased in SG group significantly until postoperative 4 week.There is a sharp decrease on insulin resistance and insulin sensitivity in DJB and GBP early, which changed the anatomy of the gut. The early effect of this improvement is not obvious in SG group, which mainly changed the volume of gastric, but SG could achieve a long-term outcome.Compared to control group, the 30 min post-prandial GLP-1, PYY, bile acid in DJB, GBP were higher than any other group, and the 30 min post-prandial Ghrelin level was decreased at postoperative 12 weeks. Which showed that the change of intestinal hormone caused by different procedures played an important role in improving glucose metabolic.