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Benefits Found in Duodenal-Jejunal Bypass Surgery

Improved metabolic function and induced moderate weight loss observed.

Researcher Samuel Klein, MD, of the Center for Human Nutrition and the Atkins Center of Excellence in Obesity Medicine at Washington University School of Medicine, St. Louis, and colleagues examined 17 adults who were overweight or obese and with T2DM. These subjects underwent standard medical care (n=7) or duodenal-jejunal bypass surgery with minimal gastric resection, DJBm (n=10). The endpoint was to determine the effect of each process on regulated glucose homeostasis.

Participants of the study were assessed for body weight, use of antidiabetics agents, and plasma lipids, and completed the 5-hour modified oral glucose tolerance test at intervals of 1, 6, and 12 months. Subjects who underwent DJBm reduced body weight by 7.9% at 1 month, 9.6% at 6 months, and 10.2% at 12 months. Comparing these outcomes to standard care, body weight was within 1% of the initial body weight for 12 months.

Researchers also found that the DJBm subjects had a lower plasma glucose concentration 2 hours after the OGTT (P = 0.039) and increased insulin sensitivity (P = 0.013), early insulin response to a glucose load (P = 0.022), and overall glycemic control. When researchers analyzed data from the standard care group, they found no significant changes. Furthermore, fasting plasma glucose concentrations and plasma HbA1c decreased in both groups; however, there were no significant differences in either group.

Authors believe that DJBm surgery improves metabolic function and glycemic control in overweight and obese patients with T2DM. Nonetheless, the DJBm procedure caused a 10% weight loss; therefore, it is not feasible to separate the effect of weight loss from the therapeutic effects of surgery. Furthermore, DJBm did not induce diabetes remission in any subject, which may explain the potential 3-fold greater reduction in weight loss compared to standard care.

Practice Pearls:

Duodenal-jejunal bypass surgery with minimal gastric resection improved metabolic function and induced moderate weight loss in adults with overweight or obesity and T2DM

Duodenal-jejunal bypass surgery is associated with lower plasma glucose concentrations, increased insulin sensitivity, and early insulin response to a glucose load

Overall glycemic control is more effective with DJBm compared to standard care

Petry, Tarissa Z., et al. “Effect of Duodenal–Jejunal Bypass Surgery on Glycemic Control in Type 2 Diabetes: A Randomized Controlled Trial.” Obesity 23.10 (2015): 1973-1979.