Facilitated Release of Endogenous Enterokines

Gastric bypass leads to rapid, sustained diabetes remission in the majority of patients who undergo this procedure and is also highly effective therapy for obesity. However, currently <1% of medically-eligible patients undergo this or other bariatric operations due to cost and safety concerns. The approach is based on data suggesting that the benefit of gastric bypass is largely due to anatomical rearrangement of the intestine which leads to accelerated delivery of nutrients to the jejunum. This rerouting of nutrients stimulates the release of multiple neural, hormonal and enterokine responses that are associated with appetite suppression and improved glucose control. In this pilot proposal the question under investigation is whether repeated rapid delivery of a mixed meal directly to the jejunum can promote weight loss and glucose control.

Inclusion criteria

• Type 2 diabetes on oral antidiabetic medication
• BMI greater than or equal to 30kg/m2
• A1C less than 9%

Exclusion criteria

• Use of any of the following medications: dipeptide-peptidase IV (DPP-IV) inhibitors (e.g., sitagliptin), GLP-1 analogs (e.g., exenatide) or medication that could alter glucose tolerance (e.g. steroids)
• Contraindication to tube (e.g. Prior upper gastrointestinal bleed, or history of easy bleeding, altered foregut anatomy due to obstruction or surgery)
• Known cardiovascular disease other than controlled hypertension.
• Pregnancy or unwilling to take contraception
• Active esophagitis
• Known hiatal hernia
• Active gastric ulcer and/or duodenal ulcers,
• Previous restrictive surgery of the gastrointestinal tract
• Crohn's disease
• Active cancer
• History of gastrointestinal hemorrhage
• Known upper gastrointestinal lesions with potential to bleed
• Use of NSAIDs or anticoagulants
• Psychiatric disorders other than mild depression
• Likely inability to adhere to study protocol including alcohol or drug dependent patients
• Type I diabetes,
• Liver, kidney or multi-organ dysfunction.
• Known eating disorders
• Inability to attend scheduled or unanticipated study visits
• Known prior abdominal problems or operations that could lead to adhesions or strictures and that could prevent the spontaneous passage of a 10 French jejunal tube if it were to dislodge distally.