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Bariatric surgery: effects on glucose homeostasis
1IRCAD-EITS (European Institute of Telesurgery), University Louis Pasteur, Strasbourg, France. f.rubino@lycos.com
Current Opinion in Clinical Nutrition and Metabolic Care
|June 17, 2006
Summary
Bariatric surgery, particularly Roux-en-Y gastric bypass, effectively treats type 2 diabetes. Mechanisms involve gastrointestinal changes, not just weight loss, suggesting diabetes is operable.
Area of Science:
- Metabolic Surgery
- Endocrinology
- Gastroenterology
Background:
- Type 2 diabetes is a significant comorbidity often associated with obesity.
- Bariatric surgery is recognized for its impact on obesity and related metabolic conditions.
Purpose of the Study:
- To review the effects of bariatric surgery on type 2 diabetes.
- To explore hypotheses on the mechanisms of diabetes control post-Roux-en-Y gastric bypass.
- To discuss the interplay between gastrointestinal anatomy and glucose regulation.
Main Methods:
- Review of clinical series and animal investigations.
- Analysis of Roux-en-Y gastric bypass and biliopancreatic diversion outcomes.
- Examination of duodenal-jejunal bypass models.
Main Results:
- Bariatric operations, especially Roux-en-Y gastric bypass and biliopancreatic diversion, achieve 80-100% diabetes remission.
- Diabetes resolution occurs rapidly, faster than attributable to weight loss alone.
- Exclusion of the duodenum and proximal jejunum is key to diabetes control, independent of weight loss.
Conclusions:
- Type 2 diabetes may be a surgically treatable condition.
- Further clinical trials are needed to identify optimal surgical candidates and procedures.
- Understanding Roux-en-Y gastric bypass mechanisms can reveal new therapeutic targets for diabetes and insulin resistance.