Advertisement

Obesity Surgery

, Volume 19, Issue 2, pp 202–206 | Cite as

Glucose Tolerance in the Proximal Versus the Distal Small Bowel in Wistar Rats

  • Marcus Vinicius Dantas de Campos MartinsEmail author
  • Antônio Augusto Peixoto
  • Alberto Schanaider
  • Christiano Costa Esposito
  • Carolina Barreira Albano Aratanha
Research Article
First Online:

Abstract

Background

Type 2 diabetes is an epidemic and insulin resistance is the central etiology of this disease. Obesity increases insulin resistance and glucose intolerance and also exacerbates metabolic abnormalities present in type 2 diabetes. Bariatric surgery is the most effective treatment for severe obesity. Most reported series show that return to euglycemia and normal insulin levels occur days after gastric bypass and biliopancreatic diversion, long before major weight loss has taken place. The mechanisms underlying this dramatic reversal of type 2 diabetes following these bariatric procedures are not well understood.

Methods

Twelve Wistar rats were fed with a palatable hyperlipidic diet for 12 weeks. Body weight, glucose, and intraperitoneal glucose tolerance test were measured regularly. On day 91, they were randomized in two groups (hindgut and controls) and operated. Twenty-one days later, the tests were done again and the hindgut group re-operated. A duodenal exclusion was done. The results of an intraperitoneal glucose tolerance test were compared after the procedures.

Results

Body weight increased regularly in all the rats. Some rats developed hyperglycemia 28 days after beginning hyperlipidic diet, but these levels returned to baseline on days 56 and 84. The glucose tolerance test showed an improvement in glycemic levels in the hindgut group 21 days after the first operation (151 ± 21mg/dl). After the second operation, despite weight loss, the glucose tolerance test of the foregut group worsened again (267 ± 53 mg/dl) (p < 0.01).

Conclusion

Comparing the “hindgut hypothesis” and the “foregut hypothesis”, our data show an improvement in the 30 min glucose tolerance test in the hindgut group.

Keywords

Diabetes mellitus Rats, Wistar Glucose intolerance Intestine, small 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Venkat Narayan KM, Gregg EW, Fagot-Campagna A, et al. Diabetes:a common, growing, serious, costly, and potentially preventable public health problem. Diabetes Res Clin Pract. 2000;50(Suppl 2):S77–84.CrossRefGoogle Scholar
  2. 2.
    Maggio CA, Pi-Sunyer FX. Obesity and type 2 diabetes. Endocrinol Metabol Clin. 2003;32(4):805–22.CrossRefGoogle Scholar
  3. 3.
    Albu J, Pi-Sunyer FX. Obesity and diabetes. In: Bray GA, Bouchard C, James WPT, editors. Handbook of obesity. New York: Marcel Dekker; 1998. p. 697–707.Google Scholar
  4. 4.
    Mokdad AH, Ford ES, Bowman BA, et al. Diabetes trends in the US:1990–1998. Diabetes Care. 2000;23:1278–83.CrossRefGoogle Scholar
  5. 5.
    Reaven GM, Banting lecture. Role of insulin resistance in human disease. Diabetes 1988;37:1595–1607.CrossRefGoogle Scholar
  6. 6.
    Olefsky JM, Kolterman OG, Scarlett JÁ. Insulin action and resistance in obesity and noninsulin-dependent type 2 diabetes mellitus. Am J Physiol. 1982;243:E15–30.PubMedGoogle Scholar
  7. 7.
    Albu J, Raja-Khan N. The management of the obese diabetic patient. Prim Care Clin Office Pract. 2003;30:465–91.CrossRefGoogle Scholar
  8. 8.
    Henry RR, Wallace P, Olefsky JM. Effects of weight loss on mechanisms of hyperglycemia in obese non-insulin-dependent diabetes mellitus 1986;35:990–8.CrossRefGoogle Scholar
  9. 9.
    Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefGoogle Scholar
  10. 10.
    Colquitt J, Clegg A, Loveman E, et al. Surgery for morbid obesity. Cochrane Database Syst Rev. 2003;(2):CD003641.Google Scholar
  11. 11.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.CrossRefGoogle Scholar
  12. 12.
    Marceau P, Hould FS, Simard S, et al. Biliopancreatic diversion with duodenal switch. World J Surg. 1998;22:947–54.CrossRefGoogle Scholar
  13. 13.
    Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998;22:936–46.CrossRefGoogle Scholar
  14. 14.
    Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–29.CrossRefGoogle Scholar
  15. 15.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have tought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.CrossRefGoogle Scholar
  16. 16.
    Hickey MS, Pories WJ, MacDonald KG, et al. A new paradigm for type 2 diabetes mellitus: could it be a disease of the foregut? Ann Surg. 1998;227:637–44.CrossRefGoogle Scholar
  17. 17.
    Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab. 2004;89:2608–15.CrossRefGoogle Scholar
  18. 18.
    Frezza EE. Are we closer to finding the treatment for type 2 diabetes mellitus in morbid obesity? Are the incretins the key to success? Obes Surg. 2004;14:999–1005.CrossRefGoogle Scholar
  19. 19.
    Holst JJ. On the physiology of GIP and GLP-1. Horm Metab Res. 2004;36:747–54.CrossRefGoogle Scholar
  20. 20.
    Kreymann B, Williams G, Ghatei MA, et al. Glucagon-like peptide 1 7–36: a physiological incretin in man. Lancet 1987;2:1300–04.CrossRefGoogle Scholar
  21. 21.
    Farilla L, Bulotta A, Hirshberg B, et al. Glucagon-like peptide 1 inhibits cell apoptosis and improves glucose responsiveness of freshly isolated human islets. Endocrinology 2003;144:5149–58.CrossRefGoogle Scholar
  22. 22.
    Patriti A, Facchiano E, Annetti C, et al. Early improvement of glucose tolerance after ileal transposition in a non-obese type 2 diabetes rat model. Obes Surg. 2005;15:1258–64.CrossRefGoogle Scholar
  23. 23.
    Pories WJ, Albrecht RJ. Etiology of type II diabetes mellitus: role of the foregut. World J Surg. 2001;25:527–31.CrossRefGoogle Scholar
  24. 24.
    Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244:741–9.CrossRefGoogle Scholar
  25. 25.
    Estadella D, Oyama LM, Damaso AR, et al. Effect of palatable diet on lipid metabolism of sedentary and exercised rats. Nutrition 2004;20:218–24.CrossRefGoogle Scholar
  26. 26.
    Vivas LAM, Jamel N, Refinetti RA, et al. Anesthetic experimental device for small animal. Acta Cir Brás. 2007;22(3):229–33.CrossRefGoogle Scholar
  27. 27.
    Patriti A, Aisa MC, Annetti C, et al. How the hindgut can cure type 2 diabetes. Ileal transposition improves glucose and beta-cell function in Goto-Kakizaki rats through an enhanced proglucagon gene expression and L-cell number. Surgery 2007;142:74–85.CrossRefGoogle Scholar
  28. 28.
    Prada PO, Zecchin HG, Torsoni MA, et al. Western diet modulates insulin signaling, c-jun N-terminal kinase activity and insulin receptor substrate-1ser307 phosphorylation in a tissue-specific fashion. Endocrinol 2005;146:1576–87.CrossRefGoogle Scholar
  29. 29.
    Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a nonobese animal model of type 2 diabetes. Ann Surg. 2004;239:1–11.CrossRefGoogle Scholar
  30. 30.
    Pacheco D, Luis DA, Romero A, et al. The effects of duodenal-jejunal exclusion on hormonal regulation of glucose metabolism in Goto_kakizaki rats. Am J Surg. 2007;194:221–4.CrossRefGoogle Scholar
  31. 31.
    Mason EE. Ileal transposition and enteroglucagon/GLP-1 in obesity (and diabetic?) surgery. Obes Surg. 1999;9:223–8.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Marcus Vinicius Dantas de Campos Martins
    • 1
    • 2
    • 5
    Email author
  • Antônio Augusto Peixoto
    • 1
  • Alberto Schanaider
    • 3
  • Christiano Costa Esposito
    • 1
  • Carolina Barreira Albano Aratanha
    • 4
  1. 1.Department of Surgery, Faculty of MedicineFederal University of Rio de JaneiroRio de JaneiroBrazil
  2. 2.Estácio de Sá UniversityRio de JaneiroBrazil
  3. 3.Experimental Surgical Center of the Department of Surgery, Faculty of MedicineFederal University of Rio de JaneiroRio de JaneiroBrazil
  4. 4.Faculty of MedicineFederal University of Rio de JaneiroRio de JaneiroBrazil
  5. 5.Barra da Tijuca–Rio de JaneiroBrazil

Personalised recommendations

Cite article

Buy options