Duodenal-jejunal by-pass liner (DJBL) is an endoscopically implantable device designed to non-invasively mimic the effects of surgical gastric by-pass. However, the exact mechanisms responsible for improved glucose control associated with DJBL are still unclear. The aim of our study was to assess the effect of DJBL on insulin sensitivity and secretion in subjects with type 2 diabetes mellitus (T2DM) and obesity. Twenty-one obese subjects with T2DM (15 males, age 52.3 ± 11.2 years) underwent the implantation of the EndoBarrier DJBL (GI Dynamics, U.S.). Anthropometric, biochemical and hormonal parameters were measured before and 10 months after the implantation of DJBL. Insulin sensitivity was assessed using euglycemic-hyperinsulinemic clamp. Standard parameters including glucose disposal rate (M) and metabolic clearance rate of glucose (MCG) were calculated based on clamp results. Over 10 months the implantation of DJBL decreased body weight (body mass index 41.6 ± 6.1 vs. 37.5 ± 4.2 kg/m2, p<0.001) and improved glucose control (fasting blood glucose 10.5 ± 2.5 vs. 8.4 ± 2.4 mmol/l, p<0.001; HbA1C 74.7 ± 17.8 vs. 55.6 ± 12.4 mmol/mol, p<0.001). These improvements were accompanied by a marked increase in insulin sensitivity as shown by the results of the euglycemic-hyperinsulinemic clamp (M 1.5 ± 0.8 vs. 2.6 ± 1.0 mg.kg-1.min-1, p<0.001; MCG 1.4 ± 0.7 vs. 2.6 ± 0.2 mg.kg-1.min-1, p<0.001). In contrast, insulin secretion was not affected by DJBL (fasting insulin 21.8 ± 13.0 vs. 18.5 ± 9.5 mIU/l, p=0.312; C-peptide 2.7 ± 1.1 vs. 2.4 ± 1.1 nmol/l, p=0.172). To conclude the improvement in glucose control associated with the implantation of Endobarrier DJBL is primarily caused by increased insulin sensitivity rather than augmented insulin secretion.
M. Kudlackova: None. M. Mraz: None. M. Haluzik: None. T. Pelikanova: None. M. Benes: None. D. Lapesova: None. D. Kobrova: None. Z. Vlasakova: None. O. Brizova: None. Z. Lacinova: None.
Institute for Clinical and Experimental Medicine (IN00023001)