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Type 2 Diabetes Mellitus: A Possible Surgically Reversible Intestinal Dysfunction

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Obesity Surgery Aims and scope

Abstract

Type 2 diabetes mellitus (T2DM) is a global public health problem often associated with obesity. Bariatric surgery is effective for treating serious obesity, and techniques involving intestinal bypass have metabolic benefits, such as complete and early remission of T2DM. We present a literature review of the possible mechanisms of early normalization of glycemic homeostasis after bariatric surgery, including intestinal gluconeogenesis, increased antidiabetogenic signals from L cells located in the distal small intestine, and impaired secretion of diabetogenic signals in the upper part of the small intestine. Adding to these potential mechanisms, unknown factors that regulate insulin sensitivity may be involved and altered by bariatric surgery. This review discusses the various hypotheses about the mechanisms of glycemic control after bariatric surgery involving intestinal bypass. Further research is essential to better understand these mechanisms and to identify potential new mechanisms that might help in developing less invasive and safer alternatives for the treatment of T2DM and reveal novel pharmaceutical targets for glycemic control.

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Acknowledgments

The author is grateful to the members of her team and her many collaborators, among them the designer André Galleoti Kobal, who produced the figures.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterology—Digestive Surgery Discipline (LIM 35), University of São Paulo—Medical School, Av. Dr. Arnaldo, 455, Cerqueira César, CEP: 01246-930, São Paulo, SP, Brazil

    Priscila C. Sala, Raquel S. Torrinhas & Dan L. Waitzberg

  2. Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808-4124, USA

    Steven B. Heymsfield

  3. Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo—LIM 35, University of São Paulo—Medical School, Av. Dr. Arnaldo, 455, Cerqueira César, CEP: 01246-903, São Paulo, SP, Brazil

    Priscila C. Sala

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  1. Priscila C. Sala
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Sala, P.C., Torrinhas, R.S., Heymsfield, S.B. et al. Type 2 Diabetes Mellitus: A Possible Surgically Reversible Intestinal Dysfunction. OBES SURG 22, 167–176 (2012). https://doi.org/10.1007/s11695-011-0563-2

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