PMID- 27222547
OWN - NLM
STAT- MEDLINE
DCOM- 20170928
LR  - 20220408
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Print)
IS  - 0149-5992 (Linking)
VI  - 39
IP  - 6
DP  - 2016 Jun
TI  - Mechanisms of Diabetes Improvement Following Bariatric/Metabolic Surgery.
PG  - 893-901
LID - 10.2337/dc16-0145 [doi]
AB  - More than 20 years ago, Pories et al. published a seminal article, "Who Would 
      Have Thought It? An Operation Proves to Be the Most Effective Therapy for 
      Adult-Onset Diabetes Mellitus." This was based on their observation that 
      bariatric surgery rapidly normalized blood glucose levels in obese people with 
      type 2 diabetes mellitus (T2DM), and 10 years later, almost 90% remained diabetes 
      free. Pories et al. suggested that caloric restriction played a key role and that 
      the relative contributions of proximal intestinal nutrient exclusion, rapid 
      distal gut nutrient delivery, and the role of gut hormones required further 
      investigation. These findings of T2DM improvement/remission after bariatric 
      surgery have been widely replicated, together with the observation that bariatric 
      surgery prevents or delays incident T2DM. Over the ensuing two decades, important 
      glucoregulatory roles of the gastrointestinal (GI) tract have been firmly 
      established. However, the physiological and molecular mechanisms underlying the 
      beneficial glycemic effects of bariatric surgery remain incompletely understood. 
      In addition to the mechanisms proposed by Pories et al., changes in bile acid 
      metabolism, GI tract nutrient sensing and glucose utilization, incretins, 
      possible anti-incretin(s), and the intestinal microbiome are implicated. These 
      changes, acting through peripheral and/or central pathways, lead to reduced 
      hepatic glucose production, increased tissue glucose uptake, improved insulin 
      sensitivity, and enhanced beta-cell function. A constellation of factors, rather 
      than a single overarching mechanism, likely mediate postoperative glycemic 
      improvement, with the contributing factors varying according to the surgical 
      procedure. Thus, different bariatric/metabolic procedures provide us with 
      experimental tools to probe GI tract physiology. Embracing this approach through 
      the application of detailed phenotyping, genomics, metabolomics, and gut 
      microbiome studies will enhance our understanding of metabolic regulation and 
      help identify novel therapeutic targets.
CI  - (c) 2016 by the American Diabetes Association. Readers may use this article as long 
      as the work is properly cited, the use is educational and not for profit, and the 
      work is not altered.
FAU - Batterham, Rachel L
AU  - Batterham RL
AD  - Centre for Obesity Research, Department of Medicine, University College London, 
      London, U.K. Bariatric Centre for Weight Management and Metabolic Surgery, 
      University College London Hospital, London, U.K. National Institute for Health 
      Research, Biomedical Research Centre, University College London Hospital, London, 
      U.K. r.batterham@ucl.ac.uk.
FAU - Cummings, David E
AU  - Cummings DE
AD  - VA Puget Sound Health Care System and Diabetes and Obesity Center of Excellence, 
      University of Washington, Seattle, WA.
LA  - eng
GR  - R01 DK084324/DK/NIDDK NIH HHS/United States
GR  - R01 DK089528/DK/NIDDK NIH HHS/United States
GR  - R01 DK103842/DK/NIDDK NIH HHS/United States
GR  - U34 DK107917/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
RN  - 0 (Blood Glucose)
RN  - 0 (Gastrointestinal Hormones)
RN  - 0 (Incretins)
RN  - IY9XDZ35W2 (Glucose)
SB  - IM
CIN - Diabetes Care. 39:857.
CIN - Diabetes Care. 39:861.
CIN - Diabetes Care. 39:878.
CIN - Diabetes Care. 39:884.
CIN - Diabetes Care. 39:902.
CIN - Diabetes Care. 39:912.
CIN - Diabetes Care. 39:924.
CIN - Diabetes Care. 39:934.
CIN - Diabetes Care. 39:941.
CIN - Diabetes Care. 39:949.
CIN - Diabetes Care. 39:954.
MH  - *Bariatric Surgery/methods
MH  - Blood Glucose/metabolism
MH  - Caloric Restriction
MH  - Diabetes Mellitus, Type 2/blood/*surgery
MH  - Energy Metabolism/physiology
MH  - Gastrointestinal Hormones/physiology
MH  - Gastrointestinal Tract/metabolism/physiology
MH  - Glucose/metabolism
MH  - Humans
MH  - Incretins/metabolism
MH  - Insulin Resistance
MH  - Obesity/diet therapy/surgery
MH  - Remission Induction
MH  - Signal Transduction/physiology
MH  - Weight Loss/physiology
PMC - PMC5864134
EDAT- 2016/05/26 06:00
MHDA- 2017/09/29 06:00
PMCR- 2017/06/01
CRDT- 2016/05/26 06:00
PHST- 2016/01/22 00:00 [received]
PHST- 2016/03/21 00:00 [accepted]
PHST- 2016/05/26 06:00 [entrez]
PHST- 2016/05/26 06:00 [pubmed]
PHST- 2017/09/29 06:00 [medline]
PHST- 2017/06/01 00:00 [pmc-release]
AID - 39/6/893 [pii]
AID - 0145 [pii]
AID - 10.2337/dc16-0145 [doi]
PST - ppublish
SO  - Diabetes Care. 2016 Jun;39(6):893-901. doi: 10.2337/dc16-0145.