Bariatric surgery: effects on glucose homeostasis.

Full Abstract

PURPOSE

OF REVIEW:
This article provides an overview of the effect of bariatric surgery on type 2 diabetes. It focuses on current hypotheses about the mechanism of diabetes control after Roux-en-Y gastric bypass surgery, and discusses the relationship between gastrointestinal anatomy and glucose homeostasis.

RECENT FINDINGS:
Along with sustained body weight loss, all bariatric operations lead to improvement or resolution of comorbid disease states, particularly type 2 diabetes. Roux-en-Y gastric bypass and biliopancreatic diversion are the most effective methods to control diabetes, resulting in persistent normal concentrations of plasma glucose, insulin, and glycosylated haemoglobin in 80-100% of cases. Resolution of diabetes after such treatment typically occurs too fast to be accounted for by weight loss alone. Recent animal investigations using duodenal-jejunal bypass, a stomach-preserving experimental model of Roux-en-Y gastric bypass, have shown that diabetes control is not a mere collateral effect of the treatment of obesity, but directly results from the exclusion of the duodenum and proximal jejunum from the flow of nutrients.

SUMMARY:
Results from clinical series and animal studies suggest that type 2 diabetes is a potentially operable disease. This indicates the need for carefully conducted clinical trials to define the ideal candidate patients and the most suitable type of operation for surgical treatment of type 2 diabetes. Understanding the exact mechanism by which Roux-en-Y gastric bypass controls diabetes is a priority because such knowledge may help us to understand the relationship between gastrointestinal physiology and insulin resistance as well as to help us identify new targets for novel antidiabetic medications.

Learn Faster Today Improve your study skills

Author information

Author/s: Rubino, Francesco (F);

Affiliation: IRCAD-EITS (European Institute of Telesurgery), University Louis Pasteur, Strasbourg, France. f.rubino(-atsign-)lycos.com

Journal and publication information

Publication Type: Journal Article; Review

Journal: Current opinion in clinical nutrition and metabolic care (Curr Opin Clin Nutr Metab Care), published in England. (Language: eng)

Reference: 2006-Jul; vol 9 (issue 4) : pp 497-507

Dates: Created 2006/06/16; Completed 2006/11/20;

PMID: 16778583, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Bariatric Surgery - adverse effects
Blood Glucose - metabolism
Diabetes Mellitus, Type 2 - surgery
Energy Metabolism - physiology

Energy Metabolism - physiology
Humans
Obesity, Morbid - surgery
Pancreas - metabolism

Associated Chemicals: Blood Glucose (0)

These are the highest related articles currently in the database:

Bariatric surgery in patients with morbid obesity and type 2 diabetes. 30 Jan 2008
Surgical treatment of obesity. 30 Jan 2008
Is type II diabetes mellitus (NIDDM) a surgical disease? 30 May 1992
Potential of surgery for curing type 2 diabetes mellitus. 30 Oct 2002
Restoration of euglycemia and normal acute insulin response to glucose in obese subjects with type 2 diabetes following bariatric surgery. 29 Apr 2003
Glycemic control in diabetic patients after bariatric surgery. 30 Aug 2004
The impact of laparoscopy on bariatric surgery. 9 Mar 2005
Surgical treatment for obesity: ensuring success. 30 Oct 2005
Meeting bariatric patient care needs: procedures and protocol development. 30 Oct 2005
Population-based study of trends, costs, and complications of weight loss surgeries from 1990 to 2002. 30 Oct 2005

See 100+ related articles.