Nutrient infusion bypassing duodenum-jejunum improves insulin sensitivity in glucose-tolerant and diabetic obese subjects

The mechanisms of type 2 diabetes remission after bariatric surgery is still not fully elucidated. In the present study, we tried to simulate the Roux-en-Y gastric bypass with a canonical or longer biliary limb by infusing a liquid formula diet into different intestinal sections. Nutrients (Nutrison Energy) were infused into mid-or proximal jejunum and duodenum during three successive days in 10 diabetic and 10 normal glucosetolerant subjects. Plasma glucose, insulin, C-peptide, glucagon, incretins, and nonesterified fatty acids (NEFA) were measured before and up to 360 min following. Glucose rate of appearance (R-a) and insulin sensitivity (S-I), secretion rate (ISR), and clearance were assessed by mathematical models. SI increased when nutrients were delivered in mid-jejunum vs. duodenum (S-I x 10(4) min(-1).pM(-1): 1.11 +/- 0.44 vs. 0.62 +/- 0.22, P < 0.015, in controls and 0.79 +/- 0.34 vs. 0.40 +/- 0.20, P < 0.05, in diabetic subjects), whereas glucose Ra was not affected. In controls, Sensitivity of NEFA production was doubled in mid-jejunum vs. duodenum (2.80 +/- 1.36 vs. 1.13 +/- 0.78 +/- 106, P < 0.005) and insulin clearance increased in mid-jejunum vs. duodenum (2.05 +/- 1.05 vs. 1.09 +/- 0.38 l/min, P < 0.03). Bypass of duodenum and proximal jejunum by nutrients enhances insulin sensitivity, inhibits lipolysis, and increases insulin clearance. These results may further our knowledge of the effects of bariatric surgery on both insulin resistance and diabetes.