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Horm Metab Res 2016; 48(10): 630-637
DOI: 10.1055/s-0042-115175
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Beneficial Metabolic Effects of Duodenal Jejunal Bypass Liner for the Treatment of Adipose Patients with Type 2 Diabetes Mellitus: Analysis of Responders and Non-Responders

B. Stratmann   *
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
,
Y. Krepak   *
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
,
E. Schiffer
2   Numares AG, Regensburg, Germany
,
I. Jarick
2   Numares AG, Regensburg, Germany
,
M. Hauber
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
,
Y. H. Lee-Barkey
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
,
M. Fischer
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
,
D. Tschoepe
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
› Author Affiliations
Further Information

Publication History

received 05 February 2016

accepted 05 August 2016

Publication Date:
02 September 2016 (online)

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Abstract

Implantation of a duodenal-jejunal endoluminal bypass liner (DJBL) has shown to induce weight loss and to improve metabolic parameters. DJBL is a reversible endoduodenal sleeve mimicking duodenal bypass while lacking risks and limitations of bariatric surgery.

Effects on metabolic control, body mass parameters, appetite regulation, glucose tolerance, organ health, and lipid profile were determined in 16 morbidly overweight patients with type 2 diabetes mellitus. In addition, relevant hormones (leptin, ghrelin, gastric inhibitory peptide, glucagon-like peptide, and insulin) were measured by enzyme-linked immunosorbent assay (ELISA) and chemiluminescent microparticle immunoassay (CMIA) at 0, 1, 32, and 52 weeks post-implant following a mixed meal tolerance test. Lipoprotein subclasses were analysed by proton nuclear magnetic resonance (1H NMR) spectrometry. DJBL provoked weight loss, a decrease in fat mass, and an improvement in insulin resistance and hepatic function in most but not all of the patients, but in the long term did not increase gut hormone fasting levels pointing to a combined effect of more than gut parameters alone. Lipidome analysis was done in 10 patients, allowing classification to responders and non-responders by reduction of sLDL-p subfraction; and to further analyse the atherogenic profile. Responders showed an overall more pronounced effect regarding improvement of HbA1c, BMI, and HOMA index.

Implantation of a DJBL in obese type 2 diabetes patients does not per se lead to an improvement of the metabolic situation. Further analyses including larger cohorts have to be performed to identify responding patients, to better treat non-responders and to analyse the key effectors.

Key words

duodenal jejunal bypass liner - obesity - weight loss therapy - lipidome profiling - glucagon-like peptide-1

* These authors contributed equally to this work.


 

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