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Measurement of hepatic insulin sensitivity early after the bypass of the proximal small bowel in humans

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Title: Measurement of hepatic insulin sensitivity early after the bypass of the proximal small bowel in humans
Authors: Miras, AD
Herring, R
Vuisrikala, A
Shojaee-Moradi, F
Jackson, NC
Chandaria, S
Jackson, SN
Goldstone, AP
Hakim, N
Patel, A
Umpleby, AM
Le Roux, CW
Item Type: Journal Article
Abstract: Objective: Unlike gastric banding or sleeve gastrectomy procedures, intestinal bypass procedures, and the Roux-en-Y gastric bypass (RYGB) in particular, lead to rapid improvements in glycaemia early after surgery. The bypass of the proximal small bowel may have weight loss and even caloric restriction independent glucose-lowering properties on hepatic insulin sensitivity. In this first in humans mechanistic study, we examined this hypothesis by investigating the early effects of the duodeno-jejunal bypass liner (DJBL; GI Dynamics, USA) on the hepatic insulin sensitivity using the gold standard euglycaemic hyperinsulinaemic clamp methodology. Method: Seven patients with obesity underwent measurement of hepatic insulin sensitivity at baseline, one week after a low-calorie liquid diet and after a further one week following insertion of the DJBL whilst on the same diet. Results: DJBL did not improve the insulin sensitivity of hepatic glucose production (HGP) beyond the improvements achieved with caloric restriction. Conclusions: Caloric restriction may be the predominant driver of early increases in hepatic insulin sensitivity after the endoscopic bypass of the proximal small bowel. The same mechanism may be at play after RYGB and explain, at least in part, the rapid improvements in glycaemia.
Issue Date: 22-Sep-2016
Date of Acceptance: 22-Sep-2016
URI: http://hdl.handle.net/10044/1/40634
DOI: https://dx.doi.org/10.1002/osp4.76
ISSN: 2055-2238
Publisher: Wiley
Start Page: 95
End Page: 98
Journal / Book Title: Obesity Science & Practice
Volume: 3
Issue: 1
Copyright Statement: © 2016 The Authors. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction inany medium, provided the original work is properly cited.
Sponsor/Funder: Medical Research Council (MRC)
ONO Pharmaceuticals Co Ltd
Funder's Grant Number: G0902002
N/A
Keywords: Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
Caloric restriction
duodeno-jejunal bypass liner
endobarrier
gastric bypass
TYPE-2
EXCLUSION
SURGERY
duodeno‐jejunal bypass liner
Publication Status: Published
Appears in Collections:Department of Medicine (up to 2019)