TY - JOUR

T1 - Effects of bariatric surgery on glucose homeostasis and type 2 diabetes

AU - Bradley, David

AU - Magkos, Faidon

AU - Klein, Samuel

N1 - Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

PY - 2012

Y1 - 2012

N2 - Obesity is an important risk factor for type 2 diabetes mellitus (T2DM). Weight loss improves the major factors involved in the pathogenesis of T2DM, namely insulin action and beta cell function, and is considered a primary therapy for obese patients who have T2DM. Unfortunately, most patients with T2DM fail to achieve successful weight loss and adequate glycemic control from medical therapy. In contrast, bariatric surgery causes marked weight loss and complete remission of T2DM in most patients. Moreover, bariatric surgical procedures that divert nutrients away from the upper gastrointestinal tract are more successful in producing weight loss and remission of T2DM than those that simply restrict stomach capacity. Although upper gastrointestinal tract bypass procedures alter the metabolic response to meal ingestion, by increasing early postprandial plasma concentrations of glucagon-like peptide 1 and insulin, it is not clear whether these effects make an important contribution to long-term control of glycemia and T2DM once substantial surgery-induced weight loss has occurred. Nonetheless, the effects of surgery on body weight and metabolic function indicate that bariatric surgery should be part of the standard therapy for T2DM. More research is needed to advance our understanding of the physiological effects of different bariatric surgical procedures and possible weight loss-independent factors that improve metabolic function and contribute to the resolution of T2DM.

AB - Obesity is an important risk factor for type 2 diabetes mellitus (T2DM). Weight loss improves the major factors involved in the pathogenesis of T2DM, namely insulin action and beta cell function, and is considered a primary therapy for obese patients who have T2DM. Unfortunately, most patients with T2DM fail to achieve successful weight loss and adequate glycemic control from medical therapy. In contrast, bariatric surgery causes marked weight loss and complete remission of T2DM in most patients. Moreover, bariatric surgical procedures that divert nutrients away from the upper gastrointestinal tract are more successful in producing weight loss and remission of T2DM than those that simply restrict stomach capacity. Although upper gastrointestinal tract bypass procedures alter the metabolic response to meal ingestion, by increasing early postprandial plasma concentrations of glucagon-like peptide 1 and insulin, it is not clear whether these effects make an important contribution to long-term control of glycemia and T2DM once substantial surgery-induced weight loss has occurred. Nonetheless, the effects of surgery on body weight and metabolic function indicate that bariatric surgery should be part of the standard therapy for T2DM. More research is needed to advance our understanding of the physiological effects of different bariatric surgical procedures and possible weight loss-independent factors that improve metabolic function and contribute to the resolution of T2DM.

KW - Animals

KW - Bariatric Surgery

KW - Blood Glucose/metabolism

KW - Diabetes Mellitus, Type 2/blood

KW - Homeostasis

KW - Humans

KW - Insulin/metabolism

KW - Insulin Resistance

KW - Insulin Secretion

KW - Insulin-Secreting Cells/metabolism

KW - Obesity/surgery

U2 - 10.1053/j.gastro.2012.07.114

DO - 10.1053/j.gastro.2012.07.114

M3 - Review

C2 - 22885332

VL - 143

SP - 897

EP - 912

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 4

ER -