title: Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass.
abstract: Roux-en-Y gastric bypass (RYGB) greatly improves glycaemic control in morbidly obese patients with type 2 diabetes, in many even before significant weight loss. Understanding the responsible mechanisms may contribute to our knowledge of the pathophysiology of type 2 diabetes and help identify new drug targets or improve surgical techniques. This review summarises the present knowledge based on pathophysiological studies published during the last decade. Taken together, two main mechanisms seem to be responsible for the early improvement in glycaemic control after RYGB: (1) an increase in hepatic insulin sensitivity induced, at least in part, by energy restriction and (2) improved beta cell function associated with an exaggerated postprandial glucagon-like peptide 1 secretion owing to the altered transit of nutrients. Later a weight loss induced improvement in peripheral insulin sensitivity follows.
authors.affiliation: Department of Endocrinology 541, Hvidovre Hospital, University of Copenhagen, Kettegaard Allé 30, 2650 Hvidovre, Denmark. carsten.dirksen@hvh.regionh.dk
authors.forename: C
authors.initials: C
authors.lastname: Dirksen
authors.forename: N B
authors.initials: NB
authors.lastname: Jørgensen
authors.forename: K N
authors.initials: KN
authors.lastname: Bojsen-Møller
authors.forename: S H
authors.initials: SH
authors.lastname: Jacobsen
authors.forename: D L
authors.initials: DL
authors.lastname: Hansen
authors.forename: D
authors.initials: D
authors.lastname: Worm
authors.forename: J J
authors.initials: JJ
authors.lastname: Holst
authors.forename: S
authors.initials: S
authors.lastname: Madsbad
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000378:metabolism; D005260:Female; D015390:Gastric Bypass; D052216:Glucagon-Like Peptide 1 / Q000097:blood*; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000378:metabolism; D008297:Male; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D052216:Glucagon-Like Peptide 1