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The Sum of Many Parts: Potential Mechanisms for Improvement in Glucose Homeostasis After Bariatric Surgery

  • Pharmacologic Treatment of Type 2 Diabetes (A Vella, Section Editor)
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Abstract

Bariatric surgery has emerged as the most durably effective treatment of type 2 diabetes (DM). However, the mechanisms governing improvement in glucose homeostasis have yet to be fully elucidated. In this review we discuss the various types of surgical interventions and the multitude of factors that potentially mediate the effects on glycemia, such as altered delivery of nutrients to the distal ileum, duodenal exclusion, gut hormone changes, bile acid reabsorption, and amino acid metabolism. Accumulating evidence that some of these changes seem to be independent of weight loss questions the rationale of using body mass index as the major indication for surgery in diabetic patients. Understanding the complex mechanisms and interactions underlying improved glycemic control could lead to novel therapeutic targets and would also allow for greater individualization of therapy and optimization of surgical outcomes.

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Acknowledgments

Kim T. Nguyen has received grant support from the Endocrine Fellows Foundation.

Judith Korner has received grant support from the National Institutes of Health DK072011.

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Conflict of Interest

K. T. Nguyen declares that she has no conflict of interest. J. Korner has been a consultant for the Federal Trade Commission; has given expert testimony for the Office of Professional Misconduct; has received grant support from Covidien; and had travel/accommodations for research purposes covered or reimbursed from Novo Nordisk.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Division of Endocrinology, Columbia University Medical Center, 630 West 168th St, PH 8 West, Room 864, New York, NY, 10032, USA

    Kim T. Nguyen

  2. Division of Endocrinology and Weight Control Center, Columbia University Medical Center, 650 West 168th St, Black Bldg, Room 905, New York, NY, 10032, USA

    Judith Korner

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  1. Kim T. Nguyen
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Correspondence to Judith Korner.

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This article is part of the Topical Collection on Pharmacologic Treatment of Type 2 Diabetes

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Nguyen, K.T., Korner, J. The Sum of Many Parts: Potential Mechanisms for Improvement in Glucose Homeostasis After Bariatric Surgery. Curr Diab Rep 14, 481 (2014). https://doi.org/10.1007/s11892-014-0481-5

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