Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats

Dec 26, 2014American journal of physiology. Regulatory, integrative and comparative physiology

How Weight Loss Surgery Plus Medicine Compared to Strong Medicine or Diet Affects Blood Sugar Control in Diabetic Rats

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Abstract

Both Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (SG) significantly improved glycemic control in a rodent model of advanced Type 2 diabetes mellitus.

RYGB and SG decreased the daily insulin dose needed to maintain blood glucose levels below 15 mmol/l compared to calorie restriction or glycemia-matched rats.
No significant difference in initial efficacy was observed between RYGB and SG.
SG was associated with higher food intake, weight regain, and insulin requirements compared to RYGB at the end of the study.
Severe hypoglycemia occurred in several rats following RYGB.
While short-term outcomes from both surgeries were similar, long-term efficacy may be slightly better after RYGB, though this is accompanied by a higher risk of hypoglycemia.

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Bariatric surgery rapidly improves Type 2 diabetes mellitus (T2DM). Our objective was to profile and compare the extent and duration of improved glycemic control following Roux-en-Y gastric (RYGB) bypass surgery and vertical sleeve gastrectomy (SG) and compare against calorie restriction/weight loss and medical combination therapy-based approaches using the Zucker diabetic fatty rat (ZDF) rodent model of advanced T2DM. Male ZDF rats underwent RYGB (n = 15) or SG surgery (n = 10) at 18 wk of age and received postsurgical insulin treatment, as required to maintain mid-light-phase glycemia within a predefined range (10-15 mmol/l). In parallel, other groups of animals underwent sham surgery with ad libitum feeding (n = 6), with body weight (n = 8), or glycemic matching (n = 8) to the RYGB group, using food restriction or a combination of insulin, metformin, and liraglutide, respectively. Both bariatric procedures decreased the daily insulin dose required to maintain mid-light-phase blood glucose levels below 15 mmol/l, compared with those required by body weight or glycemia-matched rats (P < 0.001). No difference was noted between RYGB and SG with regard to initial efficacy. SG was, however, associated with higher food intake, weight regain, and higher insulin requirements vs. RYGB at study end (P < 0.05). Severe hypoglycemia occurred in several rats after RYGB. RYGB and SG significantly improved glycemic control in a rodent model of advanced T2DM. While short-term outcomes are similar, long-term efficacy appears marginally better after RYGB, although this is tempered by the increased risk of hypoglycemia.

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Effect of bariatric surgery combined with medical therapy versus intensive medical therapy or calorie restriction and weight loss on glycemic control in Zucker diabetic fatty rats

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