Abstract
Roux-en-Y gastric bypass results in large and sustained weight loss and resolution of type 2 diabetes in 60% of cases at 1–2 years. In addition to calorie restriction and weight loss, various gastro-intestinal mediated mechanisms, independent of weight loss, also contribute to glucose control. The anatomical re-arrangement of the small intestine after gastric bypass results in accelerated nutrient transit, enhances the release of post-prandial gut hormones incretins and of insulin, alters the metabolism and the entero-hepatic cycle of bile acids, modifies intestinal glucose uptake and metabolism, and alters the composition and function of the microbiome. The amelioration of beta cell function after gastric bypass in individuals with type 2 diabetes requires enteric stimulation. However, beta cell function in response to intravenous glucose stimulus remains severely impaired, even in individuals in full clinical diabetes remission. The permanent impairment of the beta cell may explain diabetes relapse years after surgery.
Highlights
Specialty section: This article was submitted to Diabetes, a section of the journal Frontiers in Endocrinology
Roux-en-Y gastric bypass (RYGB) was the dominant type of surgery performed in the US up to 2011
RYGB is the surgical model that has been studied the most to investigate gut mechanisms, independent of weight loss, that may contribute to post-operative glucose control
Summary
Specialty section: This article was submitted to Diabetes, a section of the journal Frontiers in Endocrinology. The anatomical re-arrangement of the small intestine after gastric bypass results in accelerated nutrient transit, enhances the release of post-prandial gut hormones incretins and of insulin, alters the metabolism and the entero-hepatic cycle of bile acids, modifies intestinal glucose uptake and metabolism, and alters the composition and function of the microbiome. RYGB is the surgical model that has been studied the most to investigate gut mechanisms, independent of weight loss, that may contribute to post-operative glucose control.
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