Short-term Glucose Metabolism and Gut Hormone Modulations after Billroth II Gastrojejunostomy in Nonobese Gastric Cancer Patients with Type 2 Diabetes Mellitus, Impaired Glucose Tolerance and Normal Glucose Tolerance

• Published in: Archives of medical research 2013-08, Vol.44 (6), p.437-443
• Main Authors: Zhang, Xiao-juan, Xiao, Zhu, Yu, Hong-ling, Zhang, Xiang-xun, Cheng, Zhong, Tian, Hao-ming
• Format: Article
• Language: English
• Subjects: Adult; Aged; Area Under Curve; Billroth II gastrojejunostomy; Blood Glucose - metabolism; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - surgery; Female; Gastric Bypass; Gastric Inhibitory Polypeptide - blood; Glucagon-Like Peptide 1 - metabolism; Glucose Intolerance - metabolism; Glucose metabolism; Glucose Tolerance Test; Glycated Hemoglobin A; Gut hormones; Humans; Insulin - metabolism; Internal Medicine; Male; Middle Aged; Obesity - complications; Peptide YY - metabolism; Postoperative Period; Roux-en-Y gastric bypass; Stomach Neoplasms - complications; Stomach Neoplasms - metabolism; Stomach Neoplasms - surgery; Type 2 diabetes mellitus; Weight Loss
• ISSN: 0188-4409; 1873-5487
• DOI: 10.1016/j.arcmed.2013.07.004

Background and Aims Roux-en-Y gastric bypass (RYGB) is effective in controlling blood glucose in obese patients with type 2 diabetes (T2DM). The alterations of gut hormones involving in glucose metabolism may play an important role. Our aim was to explore the short-term effects of Billroth II gastrojejunostomy (a similar type of RYGB) on glucose metabolism and gut hormone modulations in nonobese patients with different levels of blood glucose tolerance. Methods Twenty one nonobese gastric cancer patients with different levels of blood glucose tolerance were submitted to Billroth II gastrojejunostomy. Among them, seven had T2DM, seven with impaired glucose tolerance (IGT) and the other seven had normal glucose tolerance (NGT). Body weight, glucose parameters, responses of plasma glucagon-like peptide-1 (GLP-1), peptide YY (PYY) and gastric inhibitory polypeptide (GIP) to 75 g glucose were measured at baseline and 3 months after surgery. Results Similar weight losses were observed in all groups. Blood glucose was reduced in T2DM and IGT patients. Fasting and 30-min plasma glucose were increased significantly in NGT. GLP-1 showed insignificant alterations in all groups. PYY was evaluated in T2DM and IGT but remained unchanged in the NGT group. Decreased fasting and AUC GIP were observed in patients with T2DM; however, fasting and 30-min GIP were increased in NGT patients. Conclusions Billroth II gastrojejunostomy is effective in reducing blood glucose in nonobese patients with T2DM and IGT but could deteriorate early blood glucose in nonobese NGT in a 3-month time period. Variations of glucose and gut hormone changes in the three groups suggest a role of proximal intestine in the pathophysiology of T2DM.