Diabetes Metab J.  2014 Dec;38(6):406-415. 10.4093/dmj.2014.38.6.406.

A Gut Feeling to Cure Diabetes: Potential Mechanisms of Diabetes Remission after Bariatric Surgery

• Cho YM

• KMID: 2174077
• DOI: http://doi.org/10.4093/dmj.2014.38.6.406

Abstract

A cure for type 2 diabetes was once a mere dream but has now become a tangible and achievable goal with the unforeseen success of bariatric surgery in the treatment of both obesity and type 2 diabetes. Popular bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy exhibit high rates of diabetes remission or marked improvement in glycemic control. However, the mechanism of diabetes remission following these procedures is still elusive and appears to be very complex and encompasses multiple anatomical and physiological changes. In this article, calorie restriction, improved beta-cell function, improved insulin sensitivity, and alterations in gut physiology, bile acid metabolism, and gut microbiota are reviewed as potential mechanisms of diabetes remission after Roux-en-Y gastric bypass and sleeve gastrectomy.

Keyword

Bariatric surgery; Diabetes mellitus, type 2; Obesity; Roux-en-Y gastric bypass; Sleeve gastrectomy

MeSH Terms

Bariatric Surgery*
Bile
Diabetes Mellitus, Type 2
Gastrectomy
Gastric Bypass
Insulin Resistance
Metabolism
Microbiota
Obesity
Physiology

Figure

• 

  Fig. 1 Schematic representation of (A) Roux-en-Y gastric bypass and (B) sleeve gastrectomy.

• 

  Fig. 2 Potential mechanisms of diabetes remission after Roux-en-Y gastric bypass. Altered gut physiology and systemic (or circulating) factors contribute to improved metabolic states in concert after Roux-en-Y gastric bypass. See text for detailed explanation. GLP-1, glucagon-like peptide-1; PYY, peptide-YY; OXM, oxyntomodulin.

• 

  Fig. 3 Paradigm shift from surgery to medical therapy. (A) An historic example of the evolution of the anti-tuberculosis treatment and (B) the outlook for potential bariatric/metabolic medicines instead of bariatric/metabolic surgery.

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