Evidence for a metabolic mechanism in the improvement of type 2 diabetes after sleeve gastrectomy in a rodent model.

BACKGROUND: Sleeve gastrectomy (SG) is at least as effective at producing weight loss as gastric banding but may be superior in producing remission of type 2 diabetes mellitus (T2DM). The objective of this study was to elucidate mechanisms of diabetes improvement in SG beyond caloric restriction. We studied SG in Zucker Diabetic Fatty (ZDF) rats. METHODS: Twenty-eight ZDF rats were randomly assigned to 1 of 3 groups: SG, sham-operated ad lib fed (AL), or sham-operated pair fed (PF). SG and AL rats had free access to food. PF rats were fed the average daily intake of the SG group. Comparisons of caloric intake, weight loss, intraperitoneal glucose tolerance testing (IPGTT), insulin, and total ghrelin were performed preoperatively and at postoperative days 10, 20, and 30. Differences between means were evaluated using one-way ANOVA and the paired t test as appropriate. RESULTS: Postoperatively, SG rats had lower daily caloric intake than the AL controls (78.3±10.5 kcal versus 104.7±4.6 kcal). Both SG and PF groups had sustained weight loss (-5.3±3.8 g and -27.5±2.6 g, respectively); however, SG rats had significantly lower AUC for glucose after IPGTT than both controls. This is in contrast to AL controls that experienced weight gain (34.1±4.7 g) and increases in AUC for glucose after IPGTT. CONCLUSION: Although SG is considered a restrictive procedure, there is evidence for a metabolic effect by virtue of decreased insulin resistance, which may not be reproduced by PF controls.

Duke Scholars

Author Kunoor Jain-Spangler Surgery, Minimally Invasive Surgery