The sum of many parts: potential mechanisms for improvement in glucose homeostasis after bariatric surgery.
Bariatric surgery has emerged as the most durably effective treatment of type 2 diabetes (DM). However, the mechanisms governing improvement in glucose homeostasis have yet to be fully elucidated. In this review we discuss the various types of surgical interventions and the multitude of factors that potentially mediate the effects on glycemia, such as altered delivery of nutrients to the distal ileum, duodenal exclusion, gut hormone changes, bile acid reabsorption, and amino acid metabolism. Accumulating evidence that some of these changes seem to be independent of weight loss questions the rationale of using body mass index as the major indication for surgery in diabetic patients. Understanding the complex mechanisms and interactions underlying improved glycemic control could lead to novel therapeutic targets and would also allow for greater individualization of therapy and optimization of surgical outcomes.
Division of Endocrinology, Columbia University Medical Center, 630 West 168th St, PH 8 West, Room 864, New York, NY, 10032, USA.
Kim T
KT
Nguyen
Judith
J
Korner
D050110:Bariatric Surgery; D015992:Body Mass Index; D031204:Caloric Restriction; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D005947:Glucose / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006706:Homeostasis; D006801:Humans; D054795:Incretins / Q000378:metabolism; D007333:Insulin Resistance; D008297:Male; D009767:Obesity, Morbid / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D019894:Peptide YY / Q000378:metabolism; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D016896:Treatment Outcome; D015431:Weight Loss
D052216:Glucagon-Like Peptide 1; D005947:Glucose; D006442:Glycated Hemoglobin; D054795:Incretins; D019894:Peptide YY; C517652:hemoglobin A1c protein, human; C514549:peptide YY (1-36)