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

Current Diabetes Reports

, 14:481

First online:

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

  • Kim T. NguyenAffiliated withDivision of Endocrinology, Columbia University Medical Center
  • , Judith KornerAffiliated withDivision of Endocrinology and Weight Control Center, Columbia University Medical Center Email author 

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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.


Roux-en-Y gastric bypass Gastric banding Sleeve gastrectomy Biliopancreatic diversion Diabetes remission GLP-1 GIP Glucagon PYY Adiponectin Bile acids Microbiota Amino acids Taste receptors Gluconeogenesis Insulin clearance Glucose homeostasis Bariatric surgery