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Related Concept Videos

Hormones Regulating Blood Glucose01:16

Hormones Regulating Blood Glucose

Insulin is released by beta cells of the pancreas when blood glucose levels are high. It facilitates glucose absorption and utilization in insulin-dependent cells with insulin receptors on their plasma membranes. Insulin promotes glucose uptake by increasing the number of glucose transport proteins in the cell membrane, allowing glucose to enter the cell. As a result, glucose utilization and ATP production are enhanced.
In addition to accelerating glucose uptake and utilization, insulin has...
Carbohydrate Metabolism01:36

Carbohydrate Metabolism

Carbohydrates are polymers composed of molecules containing atoms of carbon, hydrogen and oxygen. One gram of carbohydrate can provide four kilo-calories of energy, which makes it the most efficient instant energy source.
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in the...
Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
Glucagon-like Receptor Agonists01:24

Glucagon-like Receptor Agonists

Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by the...
Type II Diabetes II: Pathophysiology01:24

Type II Diabetes II: Pathophysiology

PathophysiologyType 2 diabetes mellitus (T2DM ) is a chronic metabolic disorder characterized by insulin resistance and progressive pancreatic β-cell dysfunction, leading to impaired glucose homeostasis. It results from interactions among genetic predisposition, environmental factors, and metabolic stressors, such as overnutrition and a sedentary lifestyle.Insulin Resistance and Glucose DysregulationEarly T2DM involves insulin resistance in skeletal muscle, adipose tissue, and the liver.
Glucose Homeostasis: Pancreatic Islets and Insulin Secretion01:27

Glucose Homeostasis: Pancreatic Islets and Insulin Secretion

The pancreatic islets comprising only 1%-2% of the volume are highly vascularized and innervated mini-organs. They contain five endocrine cell types, including β cells that secrete insulin, which is synthesized as a single polypeptide chain, preproinsulin, processed to proinsulin, and finally to insulin and C-peptide. This process is complex and regulated, involving the Golgi complex, the endoplasmic reticulum, and the secretory granules of the β cell.
Insulin and C-peptide are co-secreted in...

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Sleeve Gastrectomy in Mice using Surgical Clips
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Bariatric surgery: unstressing or boosting the beta-cell?

G Mingrone1, M Castagneto

  • 1Department of Internal Medicine, Catholic University, Rome, Italy. gmingrone@rm.unicatt.it

Diabetes, Obesity & Metabolism
|October 13, 2009
PubMed
Summary

Bariatric surgery effectively treats severe obesity and type 2 diabetes. Procedures like bilio-pancreatic diversion and Roux-en-Y gastric bypass offer high diabetes remission rates, improving patient health outcomes.

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Area of Science:

  • Metabolic Surgery
  • Endocrinology
  • Obesity Medicine

Background:

  • Bariatric surgery is the leading treatment for severe obesity, significantly reducing mortality and improving quality of life.
  • Different surgical procedures vary in their efficacy for weight loss and comorbidity management, particularly type 2 diabetes.

Purpose of the Study:

  • To compare the effectiveness of various bariatric procedures in treating severe obesity and type 2 diabetes.
  • To explore the mechanisms behind diabetes resolution following bariatric surgery.

Main Methods:

  • Comparative analysis of bariatric procedures based on reported outcomes for weight reduction and type 2 diabetes remission.
  • Review of physiological effects of Roux-en-Y gastric bypass (RYGB) and bilio-pancreatic diversion (BPD) on glucose metabolism and insulin secretion.

Main Results:

  • Bilio-pancreatic diversion (BPD) and duodenal switch achieve the highest diabetes remission rates (98.9%).
  • Roux-en-Y gastric bypass (RYGB) shows an 83.7% success rate in diabetes resolution, with rapid improvements noted.
  • RYGB enhances incretin secretion, while BPD significantly improves insulin resistance.

Conclusions:

  • Bariatric surgery, especially BPD and RYGB, is highly effective for managing severe obesity and type 2 diabetes.
  • Distinct mechanisms, including incretin modulation and insulin resistance improvement, contribute to diabetes resolution post-surgery.
  • Further research is needed to fully elucidate the mechanisms driving diabetes remission after surgical intestinal manipulation.