Reviews and PerspectivesReviews in Basic and Clinical Gastroenterology and HepatologyEffects of Bariatric Surgery on Glucose Homeostasis and Type 2 Diabetes
Section snippets
Common Bariatric Surgical Procedures and Effects on Body Weight
Five bariatric surgical procedures are considered acceptable therapy for appropriate patients: (1) roux-en-Y gastric bypass (RYGB), (2) laparoscopic adjustable gastric banding (LAGB), (3) laparoscopic sleeve gastrectomy (LSG), (4) biliopancreatic diversion (BPD), and (5) BPD with duodenal switch (Figure 1). Bariatric surgery causes weight loss by inducing a negative balance between energy intake (or absorption) and energy expenditure. The composite of data from a series of studies found that
Effect of Bariatric Surgery on T2DM
The therapeutic superiority of bariatric surgery over medical therapy has been shown in three 1-year or 2-year prospective randomized controlled trials.21, 22, 23 In one study, 73% of patients who underwent LAGB surgery but only 13% in the medical and lifestyle therapy group achieved remission of T2DM (defined as fasting plasma glucose concentration <126 mg/dL and HbA1c <6.2% without diabetes medications).21 In the second study, 42% of subjects who underwent RYGB surgery and 37% who underwent
Assessment of Insulin Action
Insulin regulates a large number of metabolic functions across various organ systems. Therefore, reduced sensitivity to the action of insulin (ie, insulin resistance) represents a suboptimal biological response of different metabolic pathways to normal circulating insulin concentrations.43 However, it has become common to define insulin sensitivity by its effects on glucose metabolism alone, particularly the ability of insulin to stimulate glucose disposal, which occurs primarily in skeletal
Normal Beta Cell Function
The ability of pancreatic beta cells to secrete insulin in response to circulating glucose is critical for normal glucose homeostasis. This process involves a complex series of events that integrates nutritional, hormonal, and neural factors. Insulin is first synthesized as preproinsulin, which is cleaved to proinsulin and then packaged in secretory granules where it is cleaved into equimolar amounts of insulin and C-peptide. These secretory granules fuse with the cell membrane, thereby
Conclusions and Future Research Directions
Bariatric surgery is the most effective available therapy for patients with T2DM. Most patients with T2DM who are treated with RYGB surgery achieve remission of their diabetes, defined as maintaining normal or near-normal blood glucose concentrations and HbA1c without the use of diabetes medications. Remission rates as high as 95% have been reported after the BPD with duodenal switch procedure, but this operation is not widely used because of a high rate of postoperative nutritional
References (213)
- et al.
The disposal of an oral glucose load in patients with non-insulin-dependent diabetes
Metabolism
(1988) - et al.
Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery
Am J Clin Nutr
(2003) - et al.
The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass
Am J Clin Nutr
(2010) - et al.
Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: a case-control study and 3 years of follow-up
Surg Obes Relat Dis
(2012) - et al.
Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity: case-control study
Surg Obes Relat Dis
(2011) - et al.
Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review
Surg Obes Relat Dis
(2010) - et al.
Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy
Surg Obes Relat Dis
(2011) - et al.
Type 2 diabetes in obese patients with body mass index of 30-35 kg/m2: sleeve gastrectomy versus medical treatment
Surg Obes Relat Dis
(2012) - et al.
Early outcomes of bariatric surgery in patients with metabolic syndrome: an analysis of the bariatric outcomes longitudinal database
J Am Coll Surg
(2012) - et al.
Remission of type 2 diabetes after Roux-en-Y gastric bypass is associated with greater weight loss
Surg Obes Relat Dis
(2009)
Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass
Surg Obes Relat Dis
Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass
Surg Obes Relat Dis
Early insulin sensitivity after restrictive bariatric surgery, inconsistency between HOMA-IR and steady-state plasma glucose levels
Surg Obes Relat Dis
Improvement in peripheral glucose uptake after gastric bypass surgery is observed only after substantial weight loss has occurred and correlates with the magnitude of weight lost
J Gastrointest Surg
Validation of the insulin sensitivity index (ISI0,120): comparison with other measures
Diabetes Res Clin Pract
Glucose, insulin, and somatostatin infusion for the determination of insulin sensitivity in vivo
Metabolism
A new model to fit glucose concentration during the insulin tolerance test improving the predictive capability to estimate insulin sensitivity
Nutr Metab Cardiovasc Dis
Liver, muscle, and adipose tissue insulin action is directly related to intrahepatic triglyceride content in obese subjects
Gastroenterology
Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction
Gastroenterology
Improvement in insulin sensitivity and beta-cell function following ileal interposition with sleeve gastrectomy in type 2 diabetic patients: potential mechanisms
J Gastrointest Surg
Study of the effects of transoral gastroplasty on insulin sensitivity and secretion in obese subjects
Nutr Metab Cardiovasc Dis
Certain metabolic consequences of jejunoileal bypass
Am J Clin Nutr
Weight gain as a risk factor for clinical diabetes mellitus in women
Ann Intern Med
Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men
Diabetes Care
Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001
JAMA
Global prevalence of diabetes: estimates for the year 2000 and projections for 2030
Diabetes Care
Pharmacologic therapy for type 2 diabetes mellitus
Ann Intern Med
Contribution of abnormal muscle and liver glucose metabolism to postprandial hyperglycemia in NIDDM
Diabetes
Distinct beta-cell defects in impaired fasting glucose and impaired glucose tolerance
Diabetes
Achievement of American Diabetes Association clinical practice recommendations among U.S. adults with diabetes, 1999-2002: the National Health and Nutrition Examination Survey
Diabetes Care
Standards of medical care in diabetes - 2012
Diabetes Care
Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis
Am J Med
Changes in resting energy expenditure and body composition after weight loss following Roux-en-Y gastric bypass
Obes Surg
Body composition and energy expenditure after weight loss following bariatric surgery
J Am Coll Nutr
One-year changes in energy expenditure and serum leptin following adjustable gastric banding in obese women
Obes Surg
Bariatric surgery: a systematic review and meta-analysis
JAMA
Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2
Obes Surg
Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial
JAMA
Bariatric surgery versus intensive medical therapy in obese patients with diabetes
N Engl J Med
Bariatric surgery versus conventional medical therapy for type 2 diabetes
N Engl J Med
Early resolution of type 2 diabetes seen after Roux-en-Y gastric bypass and vertical sleeve gastrectomy
Diabetes Technol Ther
Comparable early changes in gastrointestinal hormones after sleeve gastrectomy and Roux-En-Y gastric bypass surgery for morbidly obese type 2 diabetic subjects
Surg Endosc
Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes
Surg Endosc
Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial
Arch Surg
Obesity, type 2 diabetes mellitus, and other comorbidities: a prospective cohort study of laparoscopic sleeve gastrectomy vs medical treatment
Arch Surg
Improvements in insulin sensitivity and beta-cell function (HOMA) with weight loss in the severely obeseHomeostatic model assessment
Diabet Med
Obesity and diabetes: the impact of bariatric surgery on type-2 diabetes
World J Surg
Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery
N Engl J Med
Who would have thought it?An operation proves to be the most effective therapy for adult-onset diabetes mellitus
Ann Surg
Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action
Annu Rev Med
Cited by (112)
Preconception maternal gastric bypass surgery and the impact on fetal growth parameters
2024, Surgery for Obesity and Related DiseasesClinical significance of diabetes control before metabolic surgery
2021, Surgery for Obesity and Related DiseasesLaparoscopic sleeve gastrectomy and pregnancy outcomes: A systematic review
2021, European Journal of Obstetrics and Gynecology and Reproductive BiologyHigh density lipoprotein-associated miRNA is increased following Roux-en-Y gastric bypass surgery for severe obesity
2021, Journal of Lipid Research
Conflicts of interest The authors disclose the following: S.K. serves on a Scientific Advisory Board for Ethicon Endo-Surgery. The remaining authors disclose no conflicts.
Funding Supported by National Institutes of Health grants DK37948, DK56341 (Nutrition Obesity Research Center), and UL1 RR024992 (Clinical and Translational Science Award).