title: Mechanisms of surgical control of type 2 diabetes: GLP-1 is the key factor-Maybe.
abstract: Bariatric surgery is the most effective treatment for obesity and diabetes. The 2 most commonly performed weight-loss procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy, improve glycemic control in patients with type 2 diabetes independent of weight loss. One of the early hypotheses raised to explain the immediate antidiabetic effect of RYGB was that rapid delivery of nutrients from the stomach pouch into the distal small intestine enhances enteroinsular signaling to promote insulin signaling. Given the tenfold increase in postmeal glucagon-like peptide-1 (GLP-1) response compared to unchanged integrated levels of postprandial glucose-dependent insulinotropic peptide after RYGB, enhanced meal-induced insulin secretion after this procedure was thought to be the result of elevated glucose and GLP-1 levels. In this contribution to the larger point-counterpoint debate about the role of GLP-1 after bariatric surgery, most of the focus will be on RYGB.
authors: Department of Biomedical Science, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: marzieh.salehi@cshs.org.
authors: Marzieh
authors: M
authors: Salehi
authors: Department of Medicine, Duke University, Durham, North Carolina.
authors: David A
authors: DA
authors: D'Alessio
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D052216:Glucagon-Like Peptide 1 / Q000037:antagonists & inhibitors / Q000502:physiology*; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology; D007003:Hypoglycemia / Q000209:etiology; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D010446:Peptide Fragments / Q000494:pharmacology; D019518:Postprandial Period; D015431:Weight Loss / Q000502:physiology
chemical_list: D001786:Blood Glucose; D007328:Insulin; D010446:Peptide Fragments; C083773:exendin (9-39); D052216:Glucagon-Like Peptide 1
keywords: Diabetes; GLP-1; Gastric bypass surgery; Hyperinsulinemia; Hypoglycemia