Erik Stenberg1, Anders Thorell2,3. 1. Faculty of Medicine and Health, Örebro University & Department of Surgery, Region Örebro County, Örebro, Sweden. 2. Department of Clinical Science, Danderyds Hospital, Karolinska Institutet. 3. Department of Surgery, Ersta hospital, Stockholm, Sweden.
Abstract
PURPOSE OF REVIEW: To give an updated review on the underlying mechanisms and clinical effects of improved glucose control after bariatric surgery. RECENT FINDINGS: The basic principles of the mechanism for the metabolic effects of bariatric surgery can be categorized into calorie restriction, deviation of nutrients, and reduced amounts of adipose tissue. Recent findings suggest the importance of early changes following deviation of nutrients to more distal parts of the small bowel resulting in altered release of gastrointestinal hormones, altered gut microbiota, and weight-reduction. In the long-term, loss of adipose tissue results in reduced inflammation and improved insulin sensitivity. From a clinical perspective these changes are associated with remission of diabetes in patients with morbid obesity and type 2 diabetes, prevention of diabetes in patients with insulin resistance without overt type 2 diabetes and prevention of both microvascular and macrovascular complications for all patients with morbid obesity. SUMMARY: At present, bariatric surgery remains the most effective treatment option to improve glucose control and long-term complications associated with hyperglycemia in patients with obesity.Although the mechanisms behind these metabolic effects remain only partially understood, further knowledge on these complex mechanisms may help identifying durable treatment options for morbid obesity and important metabolic comorbidities.
PURPOSE OF REVIEW: To give an updated review on the underlying mechanisms and clinical effects of improved glucose control after bariatric surgery. RECENT FINDINGS: The basic principles of the mechanism for the metabolic effects of bariatric surgery can be categorized into calorie restriction, deviation of nutrients, and reduced amounts of adipose tissue. Recent findings suggest the importance of early changes following deviation of nutrients to more distal parts of the small bowel resulting in altered release of gastrointestinal hormones, altered gut microbiota, and weight-reduction. In the long-term, loss of adipose tissue results in reduced inflammation and improved insulin sensitivity. From a clinical perspective these changes are associated with remission of diabetes in patients with morbid obesity and type 2 diabetes, prevention of diabetes in patients with insulin resistance without overt type 2 diabetes and prevention of both microvascular and macrovascular complications for all patients with morbid obesity. SUMMARY: At present, bariatric surgery remains the most effective treatment option to improve glucose control and long-term complications associated with hyperglycemia in patients with obesity.Although the mechanisms behind these metabolic effects remain only partially understood, further knowledge on these complex mechanisms may help identifying durable treatment options for morbid obesity and important metabolic comorbidities.
Authors: Erik Stenberg; Torsten Olbers; Yang Cao; Magnus Sundbom; Anders Jans; Johan Ottosson; Erik Naslund; Ingmar Näslund Journal: BMJ Open Diabetes Res Care Date: 2021-05
Authors: Said Karimzad; Paramdeep S Bilkhu; James S Wolffsohn; Srikanth Bellary; Hala Shokr; Rishi Singhal; Doina Gherghel Journal: Nutrients Date: 2022-06-14 Impact factor: 6.706
Authors: Nicholas C Penney; Derek K T Yeung; Isabel Garcia-Perez; Joram M Posma; Aleksandra Kopytek; Bethany Garratt; Hutan Ashrafian; Gary Frost; Julian R Marchesi; Sanjay Purkayastha; Lesley Hoyles; Ara Darzi; Elaine Holmes Journal: Commun Med (Lond) Date: 2022-10-07