Abstract
BackgroundConsensus exists that several bariatric surgery procedures produce a rapid improvement of glucose homeostasis in obese diabetic patients, improvement apparently uncorrelated with the degree of eventual weight loss after surgery. Several hypotheses have been suggested to account for these results: among these, the anti-incretin, the ghrelin and the lower-intestinal dumping hypotheses have been discussed in the literature. Since no clear-cut experimental results are so far available to confirm or disprove any of these hypotheses, in the present work a mathematical model of the glucose-insulin-incretin system has been built, capable of expressing these three postulated mechanisms. The model has been populated with critically evaluated parameter values from the literature, and simulations under the three scenarios have been compared.ResultsThe modeling results seem to indicate that the suppression of ghrelin release is unlikely to determine major changes in short-term glucose control. The possible existence of an anti-incretin hormone would be supported if an experimental increase of GIP concentrations were evident post-surgery. Given that, on the contrary, collected evidence suggests that GIP concentrations decrease post-surgery, the lower-intestinal dumping hypothesis would seem to describe the mechanism most likely to produce the observed normalization of Type 2 Diabetes Mellitus (T2DM) after bariatric surgery.ConclusionsThe proposed model can help discriminate among competing hypotheses in a context where definitive data are not available and mechanisms are still not clear.
Highlights
Consensus exists that several bariatric surgery procedures produce a rapid improvement of glucose homeostasis in obese diabetic patients, improvement apparently uncorrelated with the degree of eventual weight loss after surgery
One of the main diseases linked to obesity is Type 2 Diabetes Mellitus (T2DM)
We introduce a mathematical model, which approximately describes the dynamics of the glucose-insulin-incretins system, allowing for the reproduction of the known and putative effects of bariatric surgery on insulin secretion
Summary
Consensus exists that several bariatric surgery procedures produce a rapid improvement of glucose homeostasis in obese diabetic patients, improvement apparently uncorrelated with the degree of eventual weight loss after surgery. Severe obesity is one of the major problems of modern society, being related with a wide spectrum of diseases This problem has been expanding in recent years, quadrupling from 1968 to 2000, reaching almost 5% of the adult population. It is not rare that subjects undergoing bariatric surgery are affected by diabetes In such cases a very interesting side-effect of surgery has been observed since the ‘70s, that is, T2DM remission. This effect is already apparent few days after surgery, i.e. much earlier than the beginning of weight loss
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