Glucose Homeostasis Improvement After Single Anastomosis Duodenojejunal Bypass with Sleeve Gastrectomy in Goto-Kakizaki Rats.

Abstract

Background: The incidence of type 2 diabetes mellitus (T2DM) is raising with significant associated medical complications and mortality. Bariatric surgery has shown to have beneficial metabolic effects. A model of single anastomosis duodenojejunal bypass with sleeve gastrectomy (SADJB-SG) was developed in a T2DM animal model without obesity, Goto-Kakizaki (GK) rats, to evaluate the effect of the procedure on glucose homeostasis.

Methods: Fourteen 12-week old GK rats underwent SADJB-SG, while 11 underwent simulated surgery (Sham). Weight and food intake were recorded comprehensively until sacrifice. Fasting blood glucose data, as well as insulin, fructosamine, and albumin levels were measured both pre-surgically and just before sacrifice. Glucose homeostasis was also monitored by oral glucose tolerance test (OGTT) at different time points. A radiographic study was performed to assess the effect of surgery on gastric emptying.

Results: Mortality rate was 24% in the SADJB-SG and 4% in Sham rats. Despite similar food intake, the SADJB-SG showed significant weight loss coupled to a decrease in albumin levels. Glucose homeostasis improved in SADJB-SG rats after surgery, reflected in decreased blood glucose, fructosamine levels, and homeostasis model assessment of insulin resistance index (HOMA-IR). OGTT tests, conducted both post-surgery and at follow-up, demonstrated an improvement in glucose metabolism 120 min after glucose administration. However, a peak in glycemia was observed at 30 min, which negatively affected the expected AUC results. Gastric emptying was accelerated in the SADJB-SG, which could contribute to explain the observed glycemia increment, through fast glucose jejunal uptake.

Conclusion: SADJB-SG surgery improved glucose homeostasis in GK rats.