To investigate the hypoglycemic effect of Roux-en-Y gastric diversion (GBP) on type 2 non-obese diabetic rats and whether Roux-en-Y gastric diversion (GBP) has any effect on blood glucose in normal rats. Methods Male Wister rats were randomly divided into four groups, blank group (group 1), surgical group (group 2), stoma group (3), stoma+surgery group (group 4), 10 rats in each group, and the changes of fasting glucose values and insulin values before, 48 hours, one week and eight weeks after surgery were measured.
Results Fasting glucose values decreased from ( 17.50±0.82)mmol/L to (11.08±0.60)mmol/L one week after surgery in the 4 groups (P value 0.01). Fasting insulin values increased from (28.95±3.99)mIU/L to (33.83±5.61)mIU/L (P0.01) to the end of the experiment with no rebound of blood glucose. there was no significant change in blood glucose values before and after surgery in the 2 groups. Conclusion GBP can significantly reduce the blood glucose value of STZ-induced diabetic rats, and has no effect on the blood glucose of normal rats.
Diabetes mellitus is one of the chronic diseases that seriously endanger human health, among which type 2 diabetes mellitus accounts for 90% [1]. Currently, reducing the complications of diabetes is mainly through strict glycemic control, including diet, exercise, oral hypoglycemic drugs and the use of insulin, but it does not completely restore the patient’s blood glucose to normal levels. Roux-en-Y gastric diversion (GBP), which was originally used to treat obesity, has played an unexpected role in the control of type 2 diabetes and may provide a new surgical treatment for type 2 diabetes. It may provide new ideas and methods for the surgical treatment of type 2 diabetes.
The present study aimed to observe the effect of Roux-en-Y gastric diversion (GBP) on glycemic control of type 2 diabetes induced by streptozotocin (STZ), and the effect of Roux-en-Y gastric diversion (GBP) on glycemia in normal Wister rats. There is no effect.
1. Materials and methods
1.1 Materials
Forty-two 8- to 10-week-old male Wister rats, weighing 250-300 gM, were provided by the laboratory animal room of Shanxi Medical University and housed in the physiological animal laboratory of Shanxi Medical University. Streptozotocin (STZ, sanland, USA), glucose oxidase kit (Baoding Great Wall Clinical Reagent Co., Ltd.), rat endocrine assay kit (linco, insulin measurement)
1.2 Methods
The model group was given a high sugar and high fat diet for 4 weeks and then injected intraperitoneally with 1% STZ solution (pH 4.2 0.1 mmol/L sodium citrate-citric acid buffer) at 30 g/Kg for 4 weeks. The buffer was freshly prepared in an ice bath;
One week later, blood glucose was measured, and two consecutive fasting blood glucose values ≥7.8 mmol/L rats were selected as the building blocks and continued to be fed with high sugar and high fat for four weeks, and then the rats were measured with tail vein >13.6 mmol/L and stabilized for 5 days as a successful model, and a total of 20 rats became models.
The experimental animals were randomly divided into control group (group 1) and surgical group (group 2) for non-molded rats, and randomly divided into molded group (group 3) and molded+surgical group (group 4) for molded rats. There were 10 in each group. There were no significant differences in body weight, fasting blood glucose, and mean food intake between groups 1 and 2, and groups 3 and 4 before surgery.
The rats were anesthetized by intraperitoneal injection of 0.5% sodium pentobarbital (50 mg/kg) and then fixed on the operating table under aseptic conditions, and a median incision of 3 cm in the upper abdomen was made to enter the abdomen and close the gastric remote, 10 cm from the Treitz ligament to cut the jejunum, and the remote jejunum was anastomosed with the proximal gastric posterior wall, 10 cm from the gastrointestinal anastomosis. After completion, the abdominal cavity was flushed with 2 ml of gentamicin and the abdomen was closed.
The rats were fasted overnight, and 1.5ml of blood was taken from the frame vein and centrifuged at 3000r/min for 10 min after 30 min of resting, and the serum was separated to measure the fasting blood glucose and insulin value.
1.3 Statistical methods
The data were expressed as mean ± standard deviation (±s), and two-way ANOVA and t-test were performed with SPSS15.0 software, and the test level was a=0.05.
2. Results
Compared with preoperative blood glucose, there was a statistically significant decrease in blood glucose in the 4 groups from the first week after GBP (P<0.05), and the blood glucose in the 4 groups was significantly lower than that in the 3 groups at the corresponding time point at 8 weeks after surgery (P<0.05), and there was no statistically significant change in blood glucose in the 2 groups before and after surgery (P>0.05).
3, Discussion
GBP surgery was originally a procedure used for weight loss, and its hypoglycemic effect was found in a foreign review analyzing the effect of bariatric surgery on obesity [5].GBP surgery and biliopancreatic diversion, as the most effective bariatric surgery, can not only lead to significant weight loss in obese patients, but also lead to unexpected long-term control of their concomitant type 2 diabetes mellitus.
The exact mechanism by which GBP lowers glycemia in diabetes is still unclear, and the initial finding in obese patients was thought to be the result of reduced diet and weight loss in obese patients after GBP, but this was later refuted by earlier observations of obese patients after GBP [and longer-term follow-up and animal studies], Rubino et al. suggested that the absence of food in the proximal part of the small intestine after GBP, or the premature arrival of incompletely digested food in the remote small intestine, could alter gastrointestinal hormone secretion and affect insulin secretion through the “intestinal islet axis”, and increase insulin sensitivity, thereby controlling blood glucose.
Does GBP have an effect on blood glucose control in type 2 diabetes? Can GBP be widely used in patients with type 2 diabetes? In this study, we applied a non-obese animal model of type 2 diabetes and confirmed that GBP has good glycemic control effect on type 2 diabetic rats. ±0.60)mmol/L (P value 0.01).
The fasting insulin value increased from (28.95 ± 3.99) mIU/L to (33.83 ± 5.61) mIU/L (P0.01) and there was no rebound of blood glucose until the end of the experiment. there was no significant change in blood glucose value before and after surgery in group 2, and there was no statistically significant change in blood glucose value between group 1 and group 2. surgery had no effect on blood glucose in normal rats, which will be important for further study of the mechanism of action of GBP in treating diabetes. This will be of great significance for further research on the mechanism of GBP in the treatment of diabetes.
Mingrone et al [10] reported a case of a normal weight young woman with type 2 diabetes who underwent GBP surgery for celiac disease and gained weight but maintained normal serum insulin and blood glucose levels for 3 months after surgery due to unrestricted diet.
This suggests that proximal small bowel resection may be an exceptional treatment for diabetes mellitus:
(1) long-term stable glycemic control, with up to 16 years of follow-up reporting good glycemic and glycated hemoglobin control after GBP in obese patients with type 2 diabetes;
②Avoiding the need for lifelong treatment, it does not require adherence to diet control, exercise and medication;
③Reducing the burden on patients and society, and reducing the consumption of health resources;
④Due to long-term stable blood glucose control, the rate of disability and death can be reduced;
⑤ Improve the quality of life of patients. Therefore, GBP may be a cost-effective treatment for type 2 diabetes, but it has its own disadvantages. GBP can also lead to different degrees of protein, fat, fat-soluble vitamin absorption disorders and osteoporosis.
However, in overweight diabetes mellitus that is poorly treated by conventional methods, the risks and complications associated with surgery may be offset by serious diabetic complications such as diabetic nephropathy, retinopathy, neuropathy, and cardiac disease that result from poor long-term glycemic control, and GBP would have the highest risk-benefit ratio. More basic and clinical studies on the mechanism of action of GBP and the pathogenesis of diabetes are needed to determine whether GBP should be used in the clinical treatment of type 2 diabetes.