PMID- 29225893
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220314
IS  - 2052-4897 (Print)
IS  - 2052-4897 (Electronic)
IS  - 2052-4897 (Linking)
VI  - 5
IP  - 1
DP  - 2017
TI  - A novel approach to glycemic control in type 2 diabetes mellitus, partial jejunal 
      diversion: pre-clinical to clinical pathway.
PG  - e000431
LID - 10.1136/bmjdrc-2017-000431 [doi]
LID - e000431
AB  - OBJECTIVE: To explore partial jejunal diversion (PJD) via a side-to-side 
      jejuno-jejunostomy for improved glycemic control in type 2 diabetes mellitus 
      (T2DM). PJD is an anatomy-sparing, technically simple surgery in comparison to 
      the predominate metabolic procedures, Roux-en-Y gastric bypass (RYGB) and sleeve 
      gastrectomy (SG). Positive results in a rodent model prompted a human 
      proof-of-concept study. RESEARCH DESIGN AND METHODS: Pre-clinically, 71 rats were 
      studied in a model of metabolic dysfunction induced by a high-fat diet; 33 
      animals undergoing one of two lengths of PJD were compared with 18 undergoing 
      sham, 10 RYGB and 10 jejuno-ileal bypass. Clinically, 15 adult subjects with 
      treated but inadequately controlled T2DM (hemoglobin A1c (HbA1c) of 8.0%-11.0%), 
      body mass index of 27.0-40.0 kg/m(2), and C peptide >/=3 ng/mL were studied. 
      Follow-up was at 2 weeks, and 3, 6, 9, and 12 months post-PJD. RESULTS: 
      Pre-clinically, positive impacts with PJD on glucose homeostasis, cholesterol, 
      and body composition versus sham control were demonstrated. Clinically, PJD was 
      performed successfully without serious complications. Twelve months post-surgery, 
      the mean (SD) reduction from baseline in HbA1c was 2.3% (1.3) (p<0.01). 
      CONCLUSIONS: PJD may provide an anatomy sparing, low-risk, intervention for 
      poorly controlled T2DM without significant alteration of the patient's lifestyle. 
      The proof-of-concept study is limited by a small sample size and advanced 
      disease, with 80% of participants on insulin and a mean time since diagnosis of 
      over 10 years. Further study is warranted. TRIAL REGISTRATION NUMBER: 
      NCT02283632; Pre-results.
FAU - Fried, Martin
AU  - Fried M
AD  - OB Klinika a.s, Prague, Czech Republic.
AD  - 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
FAU - Dolezalova, Karin
AU  - Dolezalova K
AD  - OB Klinika a.s, Prague, Czech Republic.
AD  - 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
FAU - Chambers, Adam P
AU  - Chambers AP
AD  - GLP-1 & Obesity Pharmacology, Novo Nordisk A/S, Malov, Denmark.
FAU - Fegelman, Elliott J
AU  - Fegelman EJ
AD  - Ethicon, Inc, Cincinnati, OH, USA.
FAU - Scamuffa, Robin
AU  - Scamuffa R
AD  - Ethicon, Inc, Cincinnati, OH, USA.
FAU - Schwiers, Michael L
AU  - Schwiers ML
AD  - Ethicon, Inc, Cincinnati, OH, USA.
FAU - Waggoner, Jason R
AU  - Waggoner JR
AD  - Ethicon, Inc, Cincinnati, OH, USA.
FAU - Haluzik, Martin
AU  - Haluzik M
AD  - Institute for Clinical and Experimental Medicine, Centre for Experimental 
      Medicine, Diabetes Centre, Prague, Czech Republic.
FAU - Seeley, Randy J
AU  - Seeley RJ
AD  - Department of Surgery, Internal Medicine and Nutritional Science, University of 
      Michigan, Ann Arbor, MI, USA.
LA  - eng
SI  - ClinicalTrials.gov/NCT02283632
GR  - P30 DK020572/DK/NIDDK NIH HHS/United States
PT  - Journal Article
DEP - 20170901
PL  - England
TA  - BMJ Open Diabetes Res Care
JT  - BMJ open diabetes research & care
JID - 101641391
PMC - PMC5706485
OTO - NOTNLM
OT  - Metabolic
OT  - Surgery
OT  - Type 2 Diabetes
COIS- Competing interests: MF, KD, APC, and MH have nothing to declare. RJS currently 
      receives funding from Ethicon, Inc. EJF, RS, MLS, and JRW are employed by 
      Ethicon, Inc.
EDAT- 2017/12/12 06:00
MHDA- 2017/12/12 06:01
PMCR- 2017/09/01
CRDT- 2017/12/12 06:00
PHST- 2017/04/17 00:00 [received]
PHST- 2017/07/20 00:00 [revised]
PHST- 2017/07/26 00:00 [accepted]
PHST- 2017/12/12 06:00 [entrez]
PHST- 2017/12/12 06:00 [pubmed]
PHST- 2017/12/12 06:01 [medline]
PHST- 2017/09/01 00:00 [pmc-release]
AID - bmjdrc-2017-000431 [pii]
AID - 10.1136/bmjdrc-2017-000431 [doi]
PST - epublish
SO  - BMJ Open Diabetes Res Care. 2017 Sep 1;5(1):e000431. doi: 
      10.1136/bmjdrc-2017-000431. eCollection 2017.