Changes of bile acids and resting energy expenditure after laparoscopic cholecystectomy in type 2 diabetes patients: a prospective study.

BACKGROUND: We aimed to investigate changes of bile acids and resting energy expenditure (REE) in patients with type 2 diabetes mellitus (T2DM) after laparoscopic cholecystectomy (LC) and the role in metabolic homeostasis. METHODS: From December 2019 to December 2021, a total of 77 T2DM patients with gallbladder polyps were included in our study. Among them, 40 patients who underwent LC were enrolled into the cholecystectomy group, and 37 patients who did not undergo LC were enrolled into the control group. Preoperative and 6-months postoperative demographic data, body weight, food intake, effects on diabetes control, and biomedical variables were recorded and compared. RESULTS: The mean level of total bile acids (TBA) was higher than that in the control group (P = 0.033) and increased significantly after LC compared to baseline (P = 0.029). The REE level in the cholecystectomy group was higher than that in the control group (P = 0.032) and increased compared to the baseline (P = 0.011). The utilization of carbohydrates increased significantly after LC (P < 0.001) while the utilization of fat decreased (P < 0.001). The mean level of fasting plasma glucose (P = 0.004), hemoglobin A1C (P < 0.001), and homeostasis model assessment-insulin resistance (P = 0.045) decreased after LC. The mean level of total cholesterol (P = 0.003) and low-density lipoprotein cholesterol significantly decreased (P = 0.021), whereas the level of high-density lipoprotein cholesterol increased (P < 0.001). CONCLUSIONS: The level of REE and TBA increased after LC in patients with T2DM, and the glucose and lipid metabolism improved. Trial registration This study was registered in the Chinese Clinical Trial Registry on November 30, 2018, registered number: ChiCTR1900027823.

Biliary diversion increases resting energy expenditure leading to decreased blood glucose level in mice with type 2 diabetes.

AIMS/INTRODUCTION: Type 2 diabetes mellitus is a group of metabolism abnormalities in carbohydrates and energy. Our aim was to investigate resting energy expenditure (REE) and blood glucose changes after biliary diversion in mice with diabetes. MATERIALS AND METHODS: Male mice with diabetes were randomly divided into biliary diversion and sham groups. REE was detected by indirect calorimetry, the levels of fasting blood glucose, total bile acids and triiodothyronine were analyzed. After mice were killed, the weight amount of brown adipose tissue (BAT) and gastrocnemius was measured, and the expression level of G protein-coupled bile acid receptor and type 2 iodothyronine deiodinase in BAT and gastrocnemius were examined. RESULTS: The two groups of mice were pair-fed, the bodyweights (P < 0.001) and the fasting blood glucose level (P < 0.001) in the biliary diversion group significantly decreased 24 weeks after surgery. The intraperitoneal glucose tolerance test (P = 0.035) and oral glucose tolerance test (P = 0.027) showed improvement in glucose tolerance after surgery. The REE level significantly increased 24 weeks after surgery (P = 0.005), the levels of total bile acids (P = 0.014) and triiodothyronine (P < 0.001) increased at the 24th postoperative week. The weight ratio of BAT (P = 0.038) and gastrocnemius (P = 0.026) in the biliary diversion group were higher than that in the sham group. The expression of G protein-coupled bile acid receptor in BAT (P < 0.001) and gastrocnemius (P = 0.003) were upregulated after surgery, and the type 2 iodothyronine deiodinase expression also increased in BAT (P = 0.015) and gastrocnemius (P = 0.015). CONCLUSIONS: The REE level increased and the glucose metabolism improved in mice with diabetes after biliary diversion.

Changes of Resting Energy Expenditure in Type 2 Diabetes Rats After Roux-en-Y Gastric Bypass.

BACKGROUND: This study aimed to investigate the changes of resting energy expenditure (REE) induced by Roux-en-Y gastric bypass (RYGB) in diabetic rats. METHODS: Thirty male Goto-Kakizaki rats were randomly divided into RYGB, sham RYGB (SR), and control groups. Glucose metabolism, energy expenditure, triiodothyronine, and bile acid levels were measured. Body composition in different groups was compared after sacrifice. RESULTS: RYGB induced significant diabetic improvement, with decreased maximum food intake and body weight. There was no significant difference in the REE between the groups before surgery (P = 0.74), while the REE of the RYGB group (1.15 ± 0.17 ml/h/g) was higher than that of the SR group (0.99 ± 0.13 ml/h/g) and the control group (0.97 ± 0.13 ml/h/g, P = 0.031) at the 20th postoperative week. The ratio of white adipose tissue in the RYGB group was lower (P = 0.02), and the ratio of brown adipose tissue was higher than that of the SR group and the control group (P = 0.045). Moreover, a higher bile acid level was detected in the RYGB group (6.4 ± 1.8 µmol/L) than in the SR group (4.2 ± 1.7 µmol/L) and the control group (4.0 ± 2.0 µmol/L, P = 0.025). CONCLUSIONS: RYGB induces a higher REE level in diabetic rats. The circulating bile acid level was enhanced after surgery.