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Weight loss with/without obesity surgery reverses type 2 diabetes
Weight loss with/without obesity surgery reverses type 2 diabetes -- Posted by Sweet Zombie Jesus! on 06-13-05 08:33
The prevalence of type 2 diabetes mellitus (T2DM) and obesity in the
western world is steadily increasing. Bariatric surgery is an effective
treatment of T2DM in obese patients. The mechanism by which weight loss
surgery improves glucose metabolism and insulin resistance remains
controversial. In this review, we propose that two mechanisms
participate in the improvement of glucose metabolism and insulin
resistance observed following weight loss and bariatric surgery:
caloric restriction and weight loss. Nutrients modulate insulin
secretion through the entero-insular axis. Fat mass participates in
glucose metabolism through the release of adipocytokines.
T2DM improves after restrictive and bypass procedures, and combinations
of restrictive and bypass procedures in morbidly obese patients.
Restrictive procedures decrease caloric and nutrient intake, decreasing
the stimulation of the entero-insular axis. Gastric bypass (GBP)
operations may also affect the entero-insular axis by diverting
nutrients away from the proximal GI tract and delivering incompletely
digested nutrients to the distal GI tract. GBP and biliopancreatic
diversion combine both restrictive and bypass mechanisms.
All procedures lead to weight loss and decrease in the fat mass.
Decrease in fat mass significantly affects circulating levels of
adipocytokines, which favorably impact insulin resistance. The data
reviewed here suggest that all forms of weight loss surgery lead to
caloric restriction, weight loss, decrease in fat mass and improvement
in T2DM. This suggests that improvements in glucose metabolism and
insulin resistance following bariatric surgery result in the short-term
from decreased stimulation of the entero-insular axis by decreased
caloric intake and in the long-term by decreased fat mass and resulting
changes in release of adipocytokines. Observed changes in glucose
metabolism and insulin resistance following bariatric surgery do not
require the posit of novel regulatory mechanisms.
Obes Surg. 2005 Apr;15(4):462-73. Changes in insulin resistance
following bariatric surgery: role of caloric restriction and weight
loss. Gumbs AA, Modlin IM, Ballantyne GH.Department of Surgery, Yale
University School of Medicine, New Haven, CT, USA.
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