Intestinal and Gastric Origins for Diabetes Resolution After Bariatric Surgery

Papers of particular interest, published recently, have been highlighted as: • Of importance

1. 1.
   Diabetes. In: World Health Organization. http://www.who.int/mediacentre/factsheets/fs312/en/. Accessed 6 Dec 2017.
2. 2.
   International Diabetes Federation. IDF Diabetes Atlas. 7th ed. Available from http://www.diabetesatlas.org. Accessed 20 February 2016.
3. 3.
   Obesity and overweight. In: World Health Organization. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 6 Dec 2017.
4. 4.
   Overweight & Obesity. In: Centers for Disease Control and Prevention, www.cdc.gov/obesity/data/adult.html. Accessed 29 Aug 2017.
5. 5.
   Bariatric Surgery Procedures – ASMBS. In: American Society for Metabolic and Bariatric Surgery. https://asmbs.org/patients/bariatric-surgery-procedures. Accessed 5 Dec 2017.
6. 6.
   Buse JB, Caprio S, Cefalu WT, Ceriello A, Del Prato S, Inzucchi SE, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.  https://doi.org/10.2337/dc09-9036.CrossRefPubMedPubMedCentralGoogle Scholar
7. 7.
   Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Surg Obes Relat Dis. 2009;5:409.  https://doi.org/10.1016/j.soard.2009.04.006.Google Scholar
8. 8.
   Purnell JQ, Selzer F, Wahed AS, Pender J, Pories W, Pomp A, et al. Type 2 diabetes remission rates after laparoscopic gastric bypass and gastric banding: results of the longitudinal assessment of bariatric surgery study. Diabetes Care. 2016;39:1101–7.CrossRefPubMedPubMedCentralGoogle Scholar
9. 9.
   Pournaras DJ, Aasheim ET, Søvik TT, Andrews R, Mahon D, Welbourn R, et al. Effect of the definition of type II diabetes remission in the evaluation of bariatric surgery for metabolic disorders. Br J Surg. 2011;99:100–3.  https://doi.org/10.1002/bjs.7704.CrossRefPubMedGoogle Scholar
10. 10.
    Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143–55.  https://doi.org/10.1056/nejmoa1700459.CrossRefPubMedPubMedCentralGoogle Scholar
11. 11.
    Rubino F, Schauer PR, Kaplan LM, Cummings DE. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med. 2010;61:393–411.CrossRefPubMedGoogle Scholar
12. 12.
    Pories WJ, MacDonald KG, Flickinger EG, Dohm GL, Sinha MK, Barakat HA, et al. Is type II diabetes mellitus (NIDDM) a surgical disease? Ann Surg. 1992;215(6):633–43.CrossRefPubMedPubMedCentralGoogle Scholar
13. 13.
    • Laferrere B, Heshka S, Wang K, Khan Y, Mcginty J, Teixeira J, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care. 2007;30:1709–16.  https://doi.org/10.2337/dc06-1549. This study demonstrates that the early effects of gastric bypass on glucose metabolism are partly weight independent and mediated by an increased incretin effect. CrossRefPubMedPubMedCentralGoogle Scholar
14. 14.
    Holter MM, Dutia R, Stano SM, Prigeon RL, Homel P, Mcginty JJ, et al. Glucose metabolism after gastric banding and gastric bypass in individuals with type 2 diabetes: weight loss effect. Diabetes Care. 2016;40:7–15.  https://doi.org/10.2337/dc16-1376.CrossRefPubMedPubMedCentralGoogle Scholar
15. 15.
    Korner J, Bessler M, Cirilo LJ, Conwell IM, Daud A, restuccia NL, et al. Effects of Roux-en-Y gastric bypass surgery on fasting and postprandial concentrations of plasma ghrelin, peptide YY, and insulin. J Clin Endocrinol Metab. 2005:90:359–365 Doi:10.1210.
16. 16.
    Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54(10):2506–14.  https://doi.org/10.1007/s00125-011-2204-7.CrossRefPubMedPubMedCentralGoogle Scholar
17. 17.
    Jackness C, Karmally W, Febres G, Conwell IM, Ahmed L, Bessler M, et al. Very low-calorie diet mimics the early beneficial effect of Roux-en-Y gastric bypass on insulin sensitivity and β-cell function in type 2 diabetic patients. Diabetes. 2013;62:3027–32.  https://doi.org/10.2337/db12-1762.CrossRefPubMedPubMedCentralGoogle Scholar
18. 18.
    Cummings DE, Purnell JQ, Frayo RS, Schmidova K, Wisse BE, Weigle DS. A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes. 2001;50:1714–9.  https://doi.org/10.2337/diabetes.50.8.1714.CrossRefPubMedGoogle Scholar
19. 19.
    Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597–604.  https://doi.org/10.1056/NEJMoa1105816.CrossRefPubMedGoogle Scholar
20. 20.
    • Cummings DE, Weigle DS, Frayo RS, Breen PA, Ma MK, Dellinger EP, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346:1623–30. A seminal paper demonstrating that the increase in the plasma ghrelin levels observed with diet-induced weight loss is not seen after gastric bypass surgery-induced weight loss. CrossRefPubMedGoogle Scholar
21. 21.
    Bose M, Oliván B, Teixeira J, Pi-Sunyer FX, Laferrère B. Do incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: what are the evidence? Obes Surg. 2008;19:217–29.CrossRefPubMedPubMedCentralGoogle Scholar
22. 22.
    Thaler JP, Cummings DE. Minireview: hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocr Rev. 2009;30:409.CrossRefGoogle Scholar
23. 23.
    Ybarra J, Bobbioni-Harsch E, Chassot G, Huber O, Morel P, Assimacopoulos-Jeannet F, et al. Persistent correlation of ghrelin plasma levels with body mass index both in stable weight conditions and during gastric-bypass-induced weight loss. Obes Surg. 2008;19:327–33.CrossRefPubMedGoogle Scholar
24. 24.
    Yousseif A, Emmanuel J, Karra E, Millet Q, Elkalaawy M, Jenkinson AD, et al. Differential effects of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on appetite, circulating acyl-ghrelin, peptide YY3-36 and active GLP-1 levels in non-diabetic humans. Obes Surg. 2013;24:241–52.  https://doi.org/10.1007/s11695-013-1066-0.CrossRefPubMedCentralGoogle Scholar
25. 25.
    Patel RT, Shukla AP, Ahn SM, Moreira M, Rubino F. Surgical control of obesity and diabetes: the role of intestinal vs. gastric mechanisms in the regulation of body weight and glucose homeostasis. Obesity. 2013;22:159–69.  https://doi.org/10.1002/oby.20441.CrossRefPubMedGoogle Scholar
26. 26.
    Woods SC, D’Alessio DA. Central control of body weight and appetite. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S37–50.  https://doi.org/10.1210/jc.2008-1630.CrossRefPubMedPubMedCentralGoogle Scholar
27. 27.
    Boey D, Lin S, Enriquez RF, Lee NJ, Slack K, Couzens M, et al. PYY transgenic mice are protected against diet-induced and genetic obesity. Neuropeptides. 2008;42:19–30.  https://doi.org/10.1016/j.npep.2007.11.003.CrossRefPubMedGoogle Scholar
28. 28.
    Boey D, Lin S, Karl T, Baldock P, Lee N, Enriquez R, et al. Peptide YY ablation in mice leads to the development of hyperinsulinaemia and obesity. Diabetologia. 2006;49:1360–70.  https://doi.org/10.1007/s00125-006-0237-0.CrossRefPubMedGoogle Scholar
29. 29.
    Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy. Ann Surg. 2008;247:401–7.  https://doi.org/10.1097/sla.0b013e318156f012.CrossRefPubMedGoogle Scholar
30. 30.
    Valderas JP, Irribarra V, Boza C, de la Cruz R, Liberona Y, Acosta AM, et al. Medical and surgical treatments for obesity have opposite effects on peptide YY and appetite: a prospective study controlled for weight loss. J Clin Endocrinol Metab. 2010;95(3):1069–75.  https://doi.org/10.1210/jc.2009-0983.CrossRefPubMedGoogle Scholar
31. 31.
    Holst JJ. The physiology of glucagon-like peptide 1. Physiol Rev. 2007;87:1409–39.CrossRefPubMedGoogle Scholar
32. 32.
    Jirapinyo P, Jin DX, Qazi T, Mishra N, Thompson CCA. Meta-analysis of GLP-1 after Roux-en-Y gastric bypass: impact of surgical technique and measurement strategy. Obes Surg. 2017 Sep 5;  https://doi.org/10.1007/s11695-017-291.
33. 33.
    Rubino F, Forgione A, Cummings DE, Vix M, Gnuli D, Mingrone G, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244:741–9.CrossRefPubMedPubMedCentralGoogle Scholar
34. 34.
    Ramzy AR, Nausheen S, Chelikani PK. Ileal transposition surgery produces Ileal length-dependent changes in food intake, body weight, gut hormones and glucose metabolism in rats. Int J Obes. 2013;38(3):379–87.  https://doi.org/10.1038/ijo.2013.201.CrossRefGoogle Scholar
35. 35.
    Kindel TL, Yoder SM, Seeley RJ, D’Alessio DA, Tso P. Duodenal-jejunal exclusion improves glucose tolerance in the diabetic, Goto-Kakizaki rat by a GLP-1 receptor-mediated mechanism. J Gastrointest Surg. 2009;13:1762–72.  https://doi.org/10.1007/s11605-009-0912-9.CrossRefPubMedGoogle Scholar
36. 36.
    Chambers AP, Jessen L, Ryan K, Sisley S, Wilson-Pérez HE, Stefater MA, et al. Weight-independent changes in blood glucose homeostasis after gastric bypass or vertical sleeve gastrectomy in rats. Gastroenterology. 2011;141(3):950–8.  https://doi.org/10.1053/j.gastro.2011.05.050.CrossRefPubMedPubMedCentralGoogle Scholar
37. 37.
    Ye J, Hao Z, Mumphrey MB, Townsend RL, Patterson LM, Stylopoulos N, et al. GLP-1 receptor signaling is not required for reduced body weight after RYGB in rodents. AJP Regul Integ Comp Physiol. 2014;306(5):R352–62.  https://doi.org/10.1152/ajpregu.00491.2013.CrossRefGoogle Scholar
38. 38.
    Wilson-Pérez HE, Chambers AP, Ryan KK, Li B, Sandoval DA, Stoffers D, et al. Vertical sleeve gastrectomy is effective in two genetic mouse models of glucagon-like peptide 1 receptor deficiency. Diabetes. 2013;62(7):2380–5.  https://doi.org/10.2337/db12-1498.CrossRefPubMedPubMedCentralGoogle Scholar
39. 39.
    Lindqvist A, Spegel P, Ekelund M, Garcia Vaz E, Pierzynowski, Gomez MF, et al. Gastric bypass improves β-cell function and increases β-cell mass in a porcine model. Diabetes. 2014;63(5):1665–71.  https://doi.org/10.2337/db13-0969.CrossRefPubMedGoogle Scholar
40. 40.
    Jorgensen NB, et al. Exaggerated glucagon-like peptide 1 response is important for improved β-cell function and glucose tolerance after Roux-En-Y gastric bypass in patients with type 2 diabetes. Diabetes. 2014;63(5):1665–71.  https://doi.org/10.2337/db13-0969.CrossRefGoogle Scholar
41. 41.
    Meier JJ, Butler AE, Galasso R, Butler PC. Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased β-cell turnover. Diabetes Care. 2006;29:1554–9.  https://doi.org/10.2337/dc06-0392.CrossRefPubMedGoogle Scholar
42. 42.
    Batterham RL, Cummings DE. Mechanisms of diabetes improvement following bariatric/metabolic surgery. Diabetes Care. 2016;39(6):893–901.  https://doi.org/10.2337/dc16-0145.CrossRefPubMedPubMedCentralGoogle Scholar
43. 43.
    Aguirre V, Stylopoulos N, Grinbaum R, Kaplan LM. An endoluminal sleeve induces substantial weight loss and normalizes glucose homeostasis in rats with diet-induced obesity. Obesity. 2008;16:2585–92.CrossRefPubMedPubMedCentralGoogle Scholar
44. 44.
    Kindel TL, Martins PJ, Yoder SM, Jandacek RJ, Seeley RJ, Dalessio DA, et al. Bypassing the duodenum does not improve insulin resistance associated with diet-induced obesity in rodents. Obesity. 2010;19:380–7.CrossRefPubMedPubMedCentralGoogle Scholar
45. 45.
    Rohde U, Hedbäck N, Gluud LL, Vilsbøll T, Knop FK. Effect of the EndoBarrier gastrointestinal liner on obesity and type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2016;18:300–5.CrossRefPubMedGoogle Scholar
46. 46.
    Prawitt J, Caron S, Staels B. Bile acid metabolism and the pathogenesis of type 2 diabetes. Curr Diabet Rep. 2011;11:160–6.CrossRefGoogle Scholar
47. 47.
    Tomkin GH, Owens D. Obesity diabetes and the role of bile acids in metabolism. J Transl Intern Med. 2016;4(2):73–80.  https://doi.org/10.1515/jtim-2016-0018.CrossRefGoogle Scholar
48. 48.
    Kaska L, Sledzinski T, Chomiczewska A, Dettlaff-Pokora A, Swierczynski J. Improved glucose metabolism following bariatric surgery is associated with increased circulating bile acid concentrations and remodeling of the gut microbiome. World J Gastroenterol. 2016;22:8698–719.CrossRefPubMedPubMedCentralGoogle Scholar
49. 49.
    Dutia R, Embrey M, O’Brien CS, Haeusler RA, Agénor KK, Homel P, et al. Temporal changes in bile acid levels and 12α-hydroxylation after Roux-en-Y gastric bypass surgery in type 2 diabetes. Int J Obes. 2015;39:806–13.CrossRefGoogle Scholar
50. 50.
    Fiorucci S, Cipriani S, Baldelli F, Mencarelli A. Bile acid-activated receptors in the treatment of dyslipidemia and related disorders. Prog Lipid Res. 2010;49:171–85.CrossRefPubMedGoogle Scholar
51. 51.
    Kuipers F, Groen AK. FXR: the key to benefits in bariatric surgery? Nat Med. 2014;20:337–8.CrossRefPubMedGoogle Scholar
52. 52.
    Zhang F, Yu L, Lin X, Cheng P, He L, Li X, et al. Minireview: roles of fibroblast growth factors 19 and 21 in metabolic regulation and chronic diseases. Mol Endocrinol. 2015;29:1400–13.CrossRefPubMedPubMedCentralGoogle Scholar
53. 53.
    Raghow R. Ménage-à-trois of bariatric surgery, bile acids and the gut microbiome. World J Diabetes. 2015;6:367–70.CrossRefPubMedPubMedCentralGoogle Scholar
54. 54.
    Fiorucci S, Distrutti E. Bile acid-activated receptors, intestinal microbiota, and the treatment of metabolic disorders. Trends Mol Med. 2015;21:702–14.CrossRefPubMedGoogle Scholar
55. 55.
    Kohli R, Bradley D, Setchell KD, Eagon JC, Abumrad N, Klein S. Weight loss induced by Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. J Clin Endocrinol Metab. 2013;98:E708–12.CrossRefPubMedPubMedCentralGoogle Scholar
56. 56.
    Parker HE, Wallis K, le Roux CW, Wong KY, Reimann F, Gribble FM. Molecular mechanisms underlying bile acid-stimulated glucagon-like peptide-1 secretion. Br J Pharmacol. 2012;165:414–23.CrossRefPubMedPubMedCentralGoogle Scholar
57. 57.
    Nakatani H, Kasama K, Oshiro T, Watanabe M, Hirose H, Itoh H. Serum bile acid along with plasma incretins and serum high-molecular weight adiponectin levels are increased after bariatric surgery. Metabolism. 2009;58:1400–7.CrossRefPubMedGoogle Scholar
58. 58.
    Steinert RE, Peterli R, Keller S, Meyer-Gerspach AC, Drewe J, Peters T, et al. Bile acids and gut peptide secretion after bariatric surgery: a 1-year prospective randomized pilot trial. Obesity (Silver Spring). 2013;21:E660–8.CrossRefGoogle Scholar
59. 59.
    Belgaumkar AP, Vincent RP, Carswell KA, Hughes RD, Alaghband-Zadeh J, Mitry RR, et al. Changes in bile acid profile after laparoscopic sleeve gastrectomy are associated with improvements in metabolic profile and fatty liver disease. Obes Surg. 2016;26:1195–202.CrossRefPubMedGoogle Scholar
60. 60.
    Parekh PJ, Balart LA, Johnson DA. The influence of the gut microbiome on obesity, metabolic syndrome and gastrointestinal disease. Clin Transl Gastroenterol. 2015;6(6):e91.  https://doi.org/10.1038/ctg.2015.16.CrossRefPubMedPubMedCentralGoogle Scholar
61. 61.
    Backhed F, Ding H, Wang T, Hooper LV, Koh GY, Nagy A, et al. The gut microbiota as an environmental factor that regulates fat storage. Proc Natl Acad Scie. 2004;101:15718–23.CrossRefGoogle Scholar
62. 62.
    Nieuwdorp M, Gilijamse PW, Pai N, Kaplan LM. Role of the microbiome in energy regulation and metabolism. Gastroenterology. 2014;146:1525–33.CrossRefPubMedGoogle Scholar
63. 63.
    Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444:1027–131.CrossRefPubMedGoogle Scholar
64. 64.
    Vrieze A, Van Nood E, Holleman F, Salojarvi J, Kootte RS, Bartelsman JF, et al. Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome. Gastroenterology. 2012;143(4):913–6.  https://doi.org/10.1053/j.gastro.2012.06.031.CrossRefPubMedGoogle Scholar
65. 65.
    Perry RJ, Peng L, Barry NA, Cline GW, Zhang D, Cardone RL, et al. Acetate mediates a microbiome–brain–β-cell axis to promote metabolic syndrome. Nature. 2016;534:213–7.CrossRefPubMedPubMedCentralGoogle Scholar
66. 66.
    Furet JP, Kong LC, Tap J, Poitou C, Basdevant A, Bouillot JL, et al. Differential adaptation of human gut microbiota to bariatric surgery-induced weight loss: links with metabolic and low-grade inflammation markers. Diabetes. 2010;59:3049–57.  https://doi.org/10.2337/db10-0253.CrossRefPubMedPubMedCentralGoogle Scholar
67. 67.
    Liou AP, Paziuk M, Luevano J-M, Machineni S, Turnbaugh PJ, Kaplan LM. Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013;5(178):178ra41.  https://doi.org/10.1126/scitranslmed.3005687.CrossRefPubMedPubMedCentralGoogle Scholar
68. 68.
    • Tremaroli V, Karlsson F, Werling M, Ståhlman M, Kovatcheva-Datchary P, Olbers T, et al. Roux-en-Y gastric bypass and vertical banded gastroplasty induce long-term changes on the human gut microbiome contributing to fat mass regulation. Cell Metabolism. 2015;22(2):228–38.  https://doi.org/10.1016/j.cmet.2015.07.009. Study showing changes in the gut microbiome after RYGB and VBG, along with changes in levels of fecal and circulating metabolites; colonization of germ-free mice with stool from surgical subjects showed a reduction in fat deposition in recipients, providing evidence for the role of the microbiome in weight regulation. CrossRefPubMedPubMedCentralGoogle Scholar
69. 69.
    Ilhan ZE, DiBaise JK, Isern NG, Hoyt DW, Marcus AK, Kang DW, et al. Distinctive microbiomes and metabolites linked with weight loss after gastric bypass, but not gastric banding. ISME J. 2017;11(9):2047–58.  https://doi.org/10.1038/ismej.2017.71.CrossRefPubMedGoogle Scholar
70. 70.
    Cheung GW, Kokorovic A, Lam CK, Chari M, Lam TK. Intestinal cholecystokinin controls glucose production through a neuronal network. Cell Metab. 2009;10:99–109.CrossRefPubMedGoogle Scholar
71. 71.
    Powley TL, Chi MM, Schier LA, Phillips RJ. Obesity: should treatments target visceral afferents? Physiol Behav. 2005;86:698–708.CrossRefPubMedGoogle Scholar
72. 72.
    Sobocki J, Fourtanier G, Estany J, Otal P. Does vagal nerve stimulation affect body composition and metabolism? Experimental study of a new potential technique in bariatric surgery. Surgery. 2006;139:209–16.CrossRefPubMedGoogle Scholar
73. 73.
    Moran TH. Cholecystokinin and satiety: current perspectives. Nutrition. 2000;16:858–65.CrossRefPubMedGoogle Scholar
74. 74.
    Berthoud HR, Shin AC, Zheng H. Obesity surgery and gut-brain communication. Physiol Behav. 2011;105(1):106–19.CrossRefPubMedPubMedCentralGoogle Scholar
75. 75.
    Browning KN, Fortna SR, Hajnal A. Roux-en-Y gastric bypass reverses the effects of diet-induced obesity to inhibit the responsiveness of central vagal motoneurones. J Physiol. 2013;591:2357–72.CrossRefPubMedPubMedCentralGoogle Scholar
76. 76.
    Hao Z, Townsend RL, Mumphrey MB, Patterson LM, Ye J, Berthoud H-R. Vagal innervation of intestine contributes to weight loss after Roux-en-Y gastric bypass surgery in rats. Obes Surg. 2016, 24:2145–51.Google Scholar
77. 77.
    Skandalakis JE, Gray SW, Soria RE, Sorg JL, Rowe JS Jr. Distribution of the vagus nerve to the stomach. Am Surg. 1980;46(3):130–9.PubMedGoogle Scholar
78. 78.
    Roux CW, Neary NM, Halsey TJ, Small CJ, Martinez-Isla AM, Ghatei MA, et al. Ghrelin does not stimulate food intake in patients with surgical procedures involving vagotomy. J Clin Endocrinol Metab. 2005;90:4521–4.CrossRefPubMedGoogle Scholar
79. 79.
    Abbott CR, Monteiro M, Small CJ, Sajedi A, Smith KL, Parkinson JR, et al. The inhibitory effects of peripheral administration of peptide YY(3–36) and glucagon-like peptide-1 on food intake are attenuated by ablation of the vagal–brainstem–hypothalamic pathway. Brain Res. 2005;1044:127–31.CrossRefPubMedGoogle Scholar
80. 80.
    Breen DM, Rasmussen BA, Kokorovic A, Wang R, Cheung GW, Lam TK. Jejunal nutrient sensing is required for duodenal-jejunal bypass surgery to rapidly lower glucose concentrations in uncontrolled diabetes. Nat Med. 2012;18(6):950–5.  https://doi.org/10.1038/nm.2745.CrossRefPubMedGoogle Scholar
81. 81.
    Salinari S, Carr RD, Guidone C, Bertuzzi A, Cercone S, Riccioni ME, et al. Nutrient infusion bypassing duodenum-jejunum improves insulin sensitivity in glucose-tolerant and diabetic obese subjects. AJP Endocrinol Metab. 2013;305(1):E59–66.  https://doi.org/10.1152/ajpendo.00559.2012.CrossRefGoogle Scholar
82. 82.
    • Cavin JB, Couvelard A, Lebtahi R, Ducroc R, Arapis K, Voitellier E, et al. Differences in alimentary glucose absorption and intestinal disposal of blood glucose after Roux-en-Y gastric bypass vs sleeve gastrectomy. Gastroenterology. 2016;150(2):454–64.  https://doi.org/10.1053/j.gastro.2015.10.009. This is a recent publication pointing to intestinal adaptation as a putative mechanism for glucose control after gastric bypass and sleeve gastrectomy. CrossRefPubMedGoogle Scholar