| [Background] Type 2 diabetes mellitus(T2DM)is a group of endocrine and metabolic diseases that are characterized by glucose,protein,and fat metabolic disorders due to absolute deficiency of insulin,or reduced sensitivity of target cells to insulin.Current studies have shown that the bypassed intestine can affect the level of incretin,but its changing trend and the impact on the metabolism of glucose and lipid are still controversial.[Objective] 1.To observe the changes of incretin and related glycolipid metabolism indexes in 7 days and 1 month after the bypassed intestine in patients with T2 DM.2.To explore the relationship between the changes of incretin and glucose metabolism after the bypassed intestine.[Methods] Collected 34 cases of gastric surgery in Union Hospital of Fujian Medical University from July 2017 to February 2018,including 15 diabetic patients and 19 non-diabetic patients.The general indicators such as height,weight,systolic blood pressure(SBP)and diastolic blood pressure(DBP)were collected before operation,7 days after operation and 1 month after operation.We test the fasting blood glucose(FBG),2h postprandial blood glucose(2hPG),fasting C-peptide,2h postprandial C-peptide,glycosylated hemoglobin(HbA1c),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fasting and 2h postprandial glucagon-like peptide-1(GLP-1),gastric inhibitory polypeptide(GIP),gastrogastrin(Ghrelin),and calculate body mass index(BMI),Homeostasis model assessment of insulin resistance(HOMA-IR)and Homeostasis model assessment of β cells(HOMA-β)before operation,7 days after operation and 1 month after operation.[Results] 1.Comparison of general data: There was no significant difference in age,sex,height,weight,BMI,systolic blood pressure,diastolic blood pressure,total cholesterol,triglyceride,HDL-C,and LDL-C between the diabetic group and the control group before surgery(P>0.05).There was a significant difference in fasting blood glucose and glycosylated hemoglobin levels between the diabetic group and the control group before surgery(P<0.01).2.Comparison of glucose metabolism indicators before and after surgery: Diabetes group fasting blood glucose and postprandial 2h blood glucose increased at the 7th day and 1 month after surgery compared with before surgery.The fasting blood glucose in the control group decreased at the 7th day after surgery and increased at 1 month after surgery compared with before surgery.The postprandial 2h blood glucose increased at the 7th day and 1 month after surgery compared with before surgery.HbA1 c of the diabetic group decreased at 1 month after surgery compared with before surgery,while HbA1 c of the control group increased at 1 month after surgery compared with before surgery(P<0.001).There was no significant difference in the amplitude of changes between groups.3.Comparison of islet function before and after surgery: The fasting C-peptide of the diabetic group decreased at the 7th day after surgery and increased at 1 month after surgery compared with before surgery;C peptide of postprandial 2h decreased at the 7th day and 1 month after surgery compared with before surgery.The fasting C-peptide and postprandial 2h C-peptide in the control group increased at the 7th day and 1 month after surgery compared with before surgery.HOMA-IR in the diabetic group decreased at the 7th day after surgery compared with before surgery(P<0.01)and decreased at 1 month after surgery(P<0.001).In the control group,HOMA-IR decreased at the 7th day after surgery(P<0.001)and increased at 1 month after surgery(P<0.01)compared with before surgery.HOMA-β in diabetic group decreased on the 7th day after surgery compared with before surgery(P<0.05),and decreased at 1 month after surgery compared with before surgery(P<0.01).In the control group,HOMA-β decreased at the 7th day and 1 month after surgery compared with before surgery(P<0.001).There was no significant difference in the amplitude of changes between groups.4.Comparison of gastrointestinal hormones before and after surgery: Fasting GLP-1 in diabetic group was increased at the 7th day and 1 month after surgery compared with before surgery;GLP-1 of postprandial 2h decreased at the 7th day after surgery compared with before surgery and increased at 1 month after surgery compared with before surgery.The fasting GLP-1 and GLP-1 of postprandial 2h in the control group increased at the 7th day and 1 month after surgery compared with before surgery.The fasting GIP in diabetic group decreased at the 7th day after surgery,and increased at 1 month after surgery.The GIP of postprandial 2h increased at the 7th day and 1 month postoperatively.The fasting GIP of the control group increased on the 7th day after surgery and 1 month after surgery compared with before surgery.The GIP of postprandial 2h increased at the 7th day after surgery compared with before surgery,and decreased at 1 month after surgery compared with before surgery.Fasting Ghrelin and Ghrelin of postprandial 2h in the diabetic group and the control group both increased at the 7th day and 1 month after surgery compared with before surgery(P<0.001).The increase of fasting GLP-1 in patients with diabetes was 10.99% less than that in the control group at 1 month after surgery(P<0.05).There was no difference in the amplitude of changes between groups.5.Comparison of lipid metabolism indicators before and after surgery: The body weights of the diabetic group and the control group were lower than those before surgery at 1 month after surgery.The BMI of the diabetes group and the control group decreased at 1 month after surgery compared with before surgery.The systolic blood pressure and diastolic blood pressure in the diabetic group increased at the 7th day after surgery compared with before surgery,and decreased at 1 month after surgery.In the control group,the systolic blood pressure increased at the 7th day and 1 month after surgery compared with before surgery.The diastolic blood pressure increased at the 7th day after surgery compared with before surgery,and decreased at 1 month after surgery.Triglycerides in the diabetic group and the control group were both decreased at 1 month after surgery compared with before surgery.Levels of total cholesterol in the diabetic group and control group were lower than those before surgery at 1 month after surgery.The HDL in the diabetic group decreased at 1 month after surgery compared with before surgery.The HDL in the control group increased 1 month after surgery compared with before surgery.The LDL in the diabetic group and the control group was lower than those before surgery at 1 month after surgery.[Conclusion] 1.The bypassed intestine of T2 DM patients will affect the glucose and lipid metabolism.2.Fasting and 2h postprandial GLP-1,GIP and Ghrelin increase significantly after the bypassed intestine in patients with T2 DM.3.The change of glucose and lipid metabolism in patients with T2 DM after the bypassed intestine may be related to the alteration of incretin. |
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