Objective To investigate the effect of small intestine exclusion surgery on blood glucose and oral glucose tolerance test (OGTT) in Goto-Kakizaki (GK) rat with type Ⅱ diabetes mellitus.Methods 40 GK rats were randomly divided into 5 groups:duodenal bypass (Group A,n = 8),duodenaljejunal bypass (Group B,n = 8),duodenum and total jejunum exclusion (Group C,n = 8),sub-total small intestine exclusion (Group D,n = 8),and sham-operation (Group SO,n=8).All rats were observed for 24 weeks after surgery.Fasting blood glucose was tested at 0,1,3,6,12,and 24 wk.OGTT was performed at 0,1,and 24 wk.After the administration of 3 g/kg glucose by oral gavage,blood glucose was measured in conscious rats before (baseline) and after 30,60,120,and 180 minutes.Areas under curves (AUC) were calculated by trapezoidal integration.Results Rats in group A,B,C and D had lower fasting blood glucose levels and better oral glucose tolerance as shown by lower peak and area-under-thecurve (AUC) glucose values through the entire follow-up period[group B (fasting blood glucose:(9.0±2.4) mmol/L vs.(4.4±1.0) mmol/L;OGTT peak:(20.8±3.1) mmol/L vs.(10.3±2.0) mmol/L;AUC:(2658±417) mmol·min/L vs.(1324±317) mmo·min/L,P ＜0.05 or P ＜0.01].Fasting blood glucose had no differences before 12 wk and significantly increased at 12 (9.1±2.4) mmol/L and 24 wk (10.0±2.3) mmol/L in group SO (preoperative values were (8.1±1.9) mmol/L,P ＜ 0.01.There was no differences in oral glucose tolerance as shown by lower peak and area-under-the-curve (AUC) glucose values between 0 and 1 wk (P＞0.05),while the oral glucose tolerance become worse as shown by the delay of peak,higher peak (25.6±2.0) mmoL/L vs.(21.4±2.7) mmoL/l,and AUC (3422±360) mmol·min/L vs.(2667±377) mmol·min/L.Glucose values in group SO at 24 wk compared to preoperatively (P＜0.01).Rats in group A,B,C,and D had lower fasting blood-glucose and better oral glucose tolerance compared with sham-operated group through the entire follow-up period (P＜0.05 or P＜0.01).Rats in group B had lower fasting blood-glucose and better oral glucose tolerance compared to those in group A while the effect on diabetes control in group B,C and D were similar to one another (P＞0.05).Conclusion Small intestinal exclusion containing proximal gut was effective for glucose control and improving gucose tolerance,duodeno-jejunal bypass may be applicable for diabetes control in clinical setting.

Objective To observe the curative effect on non-obese type 2 diabetes and the effect on change of glucagon-like peptide-1 (GLP-1) of gastric bypass operation. Methods Thirty-two cases of gastric ulcer with non-obese type 2 diabetes were suffered gastric bypass operation. Plasma glucose concentrations, insulin and GLP-1 were measured respectively in fasting and postprandial conditions before operation and in week 1, 2, 3 and month 1, 3, 6 after gastric bypass operation, and the body mass index (BMI), homeostasis model assessment ? cell function index (HBCI) and glycosylated hemoglobin (HbA1c, the index was detected only before operation and in month 3, 6 after operation) were also measured. The turnover of the diabetes condition in the 6th month after surgery was observed. Results Compared with the levels before operation, the fasting and postprandial plasma glucose levels were descending (P0.05). The diabetes control rate was 78.1%(25/32) overall six months after operation. Level of GLP-1 was negatively correlated with level of plasma glucose (P

Objective To investigate the effect of gastric bypass on plasma glucose and glucagonlike peptide-1 (GLP-1) during oral glucose tolerance test (OGTT) in non-obese type 2 diabetes mellitus (T2DM) patients suffering from gastric ulcer necessitating a gastrectomy.Methods Thirty-two T2DM patients undergoing gastric bypass (GBP) for gastric ulcer were enrolled in this study.All patients underwent a 3-h OGTT with 75 g glucose (in a total volume of 300 ml) preoperatively and 1 week,1 month,3 months and 6 months after operation.Plasma glucose (PG) and GLP-1 concentrations were measured before (baseline) and then 30,60,120,and 180 minutes after OGTT.Areas under curves (AUC) were calculated by trapezoidal integration.The turnover of the diabetes conditions six months after the surgery were also measured.Results FPG level was (9.5±1.0) mmol/L before surgery,and significantly decreased to (7.4±1.0) mmol/L,one week,(6.5±1.2) mmol/L,one month,(8.0±1.6) mmol/L three months and (5.8±1.0) mmol/L,six months respectively after GBP(P ＜0.01).Peak level and AUC of PG during OGTT significantly decreased at aforementioned four time points after sugery (P ＜ 0.01).Oral glucosestimulated peak levels of GLP-1 was (20±3) pmol/L before GBP,and markedly increased to (83±15)pmol/L,(86±20) pmol/L,(87±22) pmol/L and (92±20) pmol/L respectively after GBP(P＜0.01).Stimulated AUC levels of GLP-1 significantly increased from (2457±395) pmol· min/L to (6499±1227)pmol·min/L,to (7275±1475) pmol·min/L,to (7307±1575) pmol·min/L and to (7974±1594)pmol· min/L during the study respectively(P ＜0.01).BMI levels were similar before and after GBP(P＞0.05).Two patients experienced complications(infection of incision and intractable hiccup).T2DM control rate was 78% when assessed at a time point of six months later.Conclusion Gastric bypass is effective in terms of glucose control and improving gucose tolerance in non-obese T2DM,and the hypoglycemic effect may be contributed to more GLP-1 secretion after GBP,but not to weight loss.

Objective To investigate the association of serum ghrelin level with cognition, hippocampal volume, and proton magnetic resonance spectrum ( [ 1 H ]-MRS ) in patients with type 2 diabetes mellitus ( T2DM) . Methods The T2DM patients cared at the Wuhan Fourth Hospital were recruited. Data on demographic characteristics and clinical parameters were collected. Ghrelin was measured by ELISA assay. Cognitive performance was assessed by the Montreal Cognitive Assessment ( MoCA ) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The changes of metabolites in hippocampus were detected by [1 H]-MRS, including N-acetyl asparate ( NAA) , choline ( Cho) , myo-inositol ( MI) , creatine ( Cr) . All patients were divided into 2 groups[cognitive impairment (CI) and non-cognitive impairment (NCI) groups] by MoCA. Results (1) Compared with patients in NCI group, the serum ghrelin level, bilateral hippocampal volume, and NAA/Cr ratio of [1H]-MRS metabolites in CI group were decreased, but MI/Cr and Cho/Cr ratios were increased(all P<0.05). (2) Serum ghrelin was positively correlated with a variety of RBANS scores ( including immediate memory, attention, delayed memory, and total scores) , bilateral hippocampal volume, and NAA/Cr ratio of [ 1 H]-MRS metabolites in T2DM patients, but it was negatively correlated with MI/Cr ratio and Cho/Cr ratio ( all P<0. 05 ) . ( 3 ) Logistic regression analysis showed that ghrelin was a protective factor of cognition in T2DM patients. Conclusions T2DM patients with cognitive impairment had lower levels of ghrelin, and serum ghrelin was postively correlated with their cognitive performance, hippocampal volume, and [1 H]-MRS metabolites, suggesting that serum ghrelin may be involved in the occurrence and development of cognitive dysfunction in patients with T2DM.