partial jejuno-ileal diversion;type 2 diabetes mellitus;obesity

Obesity and type 2 diabetes mellitus (T2DM) are one of the most prevalent chronic diseases. New types of bariatric interventions, such as partial jejuno-ileal diversion (PJID), are becoming popular for reduction of obesity. Bile acids play an important role in lipid absorption, however can serve as signalling molecules that modulate glucose metabolism. Our study was designed to investigate the effect of PJID on the alteration of bile acid levels in patients with obesity and T2DM. Surgery was performed in 15 patients (5 males/10 females; age 47.6 ± 7.9 years; weight 117 ± 21 kg; BMI 42.1 ± 5.5 kg/m2; 9 non-T2DM/6 T2DM) who were followed up for 24 months. Meal test was used to determine postprandial bile acid levels, which were detected by liquid chromatography with mass spectrometry, and assessment was based on area under the curve. After PJID, weight loss was observed in all patients, and decrease in fasting glycaemia and glycated haemoglobin was also observed in patients with T2DM. Increase in serum levels of free bile acids and decrease levels of tau- and glycol-conjugated bile acids was observed in all patients, with the main change observed for chenodeoxycholic acid. In non-T2DM patients, there was increase in the levels of primary and free bile acids, with the main change observed for cholic acid. Reduced levels of glyco- and tau-conjugated ursodeoxycholic acid were found in T2DM patients. In all cases, this effect remained even 24 months after the surgery. PJID appears to be effective in improving glycemic control and in weight reduction. The results of the study also suggest an effect of PJID on the spectrum of bile acids, which may contribute to the overall improvement of metabolic parameters of patients. Thus, bile acids may represent a potential target in the treatment of T2DM.