title: Potential mechanisms mediating improved glycemic control after bariatric/metabolic surgery.
abstract: Conservative medical treatment for morbid obesity generally fails to sustain weight loss. On the other hand, surgical operations, so-called bariatric surgery, have evolved due to their long-term effects. The global increase in the overweight population and the introduction of laparoscopic surgery have resulted in the use of bariatric surgery spreading quickly worldwide in recent years. Recent clinical evidence suggests that bariatric surgery not only reduces body weight, but also improves secondary serious diseases, including type 2 diabetes mellitus, in so-called metabolic surgery. Moreover, several potential mechanisms mediating the improvement in glycemic control after bariatric/metabolic surgery have been proposed based on the animal and human studies. These mechanisms include changes in the levels of gastrointestinal hormones, bacterial flora, bile acids, intestinal gluconeogenesis and gastrointestinal motility as well as adipose tissue and inflammatory mediators after surgery. The mechanisms underlying improved glycemic control are expected to accelerate the promotion of both metabolic and bariatric surgery. This article describes the current status of bariatric surgery worldwide and in Japan, reviews the accumulated data for weight loss and diabetic improvements after surgery and discusses the potential mechanisms mediating improved glycemic control.
authors.affiliation: Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa cho, Otsu, Shiga, 520-2192, Japan. yhiroshi@belle.shiga-med.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa cho, Otsu, Shiga, 520-2192, Japan.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Kaida
authors.affiliation: Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa cho, Otsu, Shiga, 520-2192, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa cho, Otsu, Shiga, 520-2192, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Murata
authors.affiliation: Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa cho, Otsu, Shiga, 520-2192, Japan.
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.affiliation: Biomedical Innovation Center, Shiga University of Medical Science, Otsu, Shiga, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Tani
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism; D000818:Animals; D050110:Bariatric Surgery / Q000379:methods; D001647:Bile Acids and Salts / Q000378:metabolism; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control; D005768:Gastrointestinal Hormones / Q000378:metabolism*; D000069196:Gastrointestinal Microbiome; D005769:Gastrointestinal Motility; D005943:Gluconeogenesis; D038321:Glycemic Index; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D007413:Intestinal Mucosa / Q000378:metabolism; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000378:metabolism / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*
chemical_list: D001647:Bile Acids and Salts; D005768:Gastrointestinal Hormones; D018836:Inflammation Mediators
keywords: Bariatric surgery; Diabetes; GLP-1 (Glucagon-like peptide-1); Metabolic surgery laparoscopic sleeve gastrectomy