Ileal glucose infusion leads to increased insulin sensitivity and decreased blood glucose levels in Wistar rats.

PURPOSE OF THE STUDY: Rerouting of nutrients and/or increasing nutrient delivery to the small intestine after Roux-en-Y gastric bypass may have important potential as a diabetes treatment modality. However, it is still important question which part of the gastrointestinal tract is the most important for control of glycemia. The aim of this study was to investigate the role of different segments of the gastrointestinal tract on glucose metabolism in the physiological state. MATERIALS AND METHODS: Forty 12-week-old male Wistar rats were divided into the following four groups of 10 animals each: the gastrostomy group, the duodenostomy group, the jejunostomy group, and the ileostomy group. All rats were subjected to a glucose tolerance test by infusion of glucose via the surgically inserted tubes in the stomach (gastrostomy), in the duodenum (duodenostomy), in the jejunum (jejunostomy), or in the ileum (ileostomy). Plasma glucagon-like peptide-17-36 (GLP-17-36) and insulin levels during the glucose tolerance test were assayed and Matsuda index was calculated. RESULTS: Ileostomy rats exhibited significantly lower glycemic excursions compared with gastrostomy, duodenostomy, and jejunostomy rats. Insulin and GLP-1 levels during the glucose tolerance test were significantly higher in duodenostomy and jejunostomy rats than in gastrostomy and ileostomy rats. Matsuda index was significantly higher in ileostomy rats than in duodenostomy and jejunostomy rats. CONCLUSION: Ileal glucose infusion leads to increased insulin sensitivity, further decreasing blood glucose levels.

Intact neural system of the portal vein is important for maintaining normal glucose metabolism by regulating glucagon-like peptide-1 and insulin sensitivity.

The portal neural system may have an important role on the regulation of glucose homeostasis since activation of the gut-brain-liver neurocircuit by nutrient sensing in the proximal intestine reduces hepatic glucose production through enhanced liver insulin sensitivity. Although there have been many studies investigating the role of portal neural system, surgical denervation of the sole portal vein has not been reported to date. The aim of this study was to clarify the role of the portal neural system on the regulation of glucose homeostasis and food intake in the physiological condition. Surgical denervation of portal vein (DV) was performed in 10 male 12 week-old Wistar rats. The control was a sham operation (SO). One week after surgery, food intake and body weight were monitored; an oral glucose tolerance test (OGTT) was performed; and glucagon-like peptide-1 (GLP-1) and insulin levels during OGTT were assayed. In addition, insulinogenic index, homeostatic model assessment, and Matsuda index were calculated. All rats regained the preoperative body weight at one week after surgery. There was no significant difference in food intake between DV and SO rats. DV rats exhibited increased blood glucose levels associated with decreased insulin sensitivity but increased GLP-1 and insulin secretion during OGTT. In summary, in the physiological state, loss of the portal neural system leads to decreased insulin sensitivity and increased blood glucose levels but does not affect food intake. These data indicate that an intact portal neural system is important for maintaining normal glucose metabolism.

Enhanced Intestinal Motility during Oral Glucose Tolerance Test after Laparoscopic Sleeve Gastrectomy: Preliminary Results Using Cine Magnetic Resonance Imaging.

BACKGROUND: Enhanced secretion of glucagon-like peptide-1 (GLP-1) has been suggested as a possible mechanism underlying the improvement in type 2 diabetes mellitus (T2DM) after laparoscopic sleeve gastrectomy (LSG). However, the reason for enhanced GLP-1 secretion during glucose challenge after LSG remains unclear because LSG does not include intestinal bypass. In this study, we focused on the effects of LSG on GLP-1 secretion and intestinal motility during the oral glucose tolerance test (OGTT) using cine magnetic resonance imaging (MRI) before and 3 months after LSG. METHODS: LSG was performed in 12 obese patients with a body mass index >35 kg/m(2). Six patients had T2DM. OGTT was performed before and 3 months after the surgery. Body weight, hemoglobin A1c (HbA1c), and GLP-1 levels during OGTT were examined, and intestinal motility during OGTT was assessed using cine MRI. RESULTS: Body weight was significantly decreased after surgery in all the cases. HbA1c was markedly decreased in all the diabetic subjects. In all cases, GLP-1 secretion during OGTT was enhanced and cine MRI showed markedly increased intestinal motility at 15 and 30 min during OGTT after LSG. CONCLUSIONS: LSG leads to accelerated intestinal motility and reduced intestinal transit time, which may be involved in the mechanism underlying enhanced GLP-1 secretion during OGTT after LSG.

Effect of sleeve gastrectomy on body weight, food intake, glucose tolerance, and metabolic hormone level in two different rat models: Goto-Kakizaki and diet-induced obese rat.

BACKGROUND: It is still an important question whether sleeve gastrectomy (SG) is appropriate only in the context of obesity-the condition for which it was originally developed-or whether lean people with insulin-deficient diabetes might also benefit. The aim of this study is to evaluate the effects of SG in Goto-Kakizaki (GK) and diet-induced obese (DIO) rats that have distinct characteristics in beta-cell function and fat mass. MATERIALS AND METHODS: SG was performed in GK and DIO rats. Body weight, food intake, and fasting blood glucose were monitored after surgery. Des-acyl ghrelin in fasting condition and blood glucose, insulin, and glucagon-like peptide-1 levels during meal test were measured. Homeostatic model assessment and insulinogenic index were examined. RESULTS: In both GK and DIO rats, SG improved glucose tolerance with increased glucagon-like peptide-1 and insulin secretion during meal test, and reduced fasting des-acyl ghrelin levels. Insulin sensitivity was enhanced after SG in DIO rats. The improvement in glucose tolerance after SG was shown earlier in DIO rats than in GK rats and weight regain after SG occurred faster and was more prominent in GK rats than in DIO rats. CONCLUSIONS: In both DIO and GK rats, SG could improve glucose tolerance with increased insulin secretion and/or action. The improvement in glucose tolerance was shown earlier in DIO rats than in GK rats.