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Physiologic Mechanisms of Type II Diabetes Mellitus Remission Following Bariatric Surgery: a Meta-analysis and Clinical Implications

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  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

As obesity prevalence grows in the USA, metabolic syndrome is becoming increasingly more common. Current theories propose that insulin resistance is responsible for the hypertension, dyslipidemia, type II diabetes mellitus (T2DM), and low HDL that comprise metabolic syndrome. Bariatric surgery is one potential treatment, and its effects include permanently altering the patient’s physiology and glucose regulation. Consequently, patients with T2DM who undergo bariatric surgery often experience tighter glucose control or remission of their T2DM altogether. This meta-analysis aims to explore the physiologic mechanisms underlying T2DM remission following bariatric surgery, which demonstrates effects that could lead to expansion of the NIH criteria for bariatric surgery candidates.

Methods

A comprehensive search was conducted in PubMed and Scopus. Two independent reviewers conducted title, abstract, and full text review of papers that met inclusion criteria. Papers that measured hormone levels before and after bariatric surgery were included in the meta-analysis. Weighted means and standard deviations were calculated for preoperative and postoperative GLP-1, GIP, ghrelin, and glucagon.

Results

Total postprandial GLP-1 increased following bariatric surgery, which correlated with improvements in measures of glycemic control. Fasting GLP-1, fasting GIP, total postprandial GIP, total fasting ghrelin, and fasting glucagon all decreased, but all changes in hormones evaluated failed to reach statistical significance. Studies also demonstrated changes in hepatic and peripancreatic fat, inflammatory markers, miRNA, and gut microbiota following bariatric surgery.

Conclusion

While this meta-analysis sheds light on possible mechanisms, further studies are necessary to determine the dominant mechanism underlying remission of T2DM following bariatric surgery.

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Authors and Affiliations

  1. University of Illinois College of Medicine, Chicago, USA

    Sarah M. Russel & Takshaka Patel

  2. Department of Surgery, University of Illinois College of Medicine, Chicago, USA

    Valentina Valle, Giuditta Spagni & Antonio Gangemi

  3. Loyola University Chicago, Chicago, USA

    Sarah Hamilton

  4. Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago, Chicago, USA

    Nurlan Abdukadyrov & Yushen Dong

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  1. Sarah M. Russel
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  2. Valentina Valle
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  4. Sarah Hamilton
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Contributions

Sarah M. Russel, B.S.: methodology, formal analysis, investigation, writing–original draft, and writing–review and editing

Valentina Valle, M.D.: methodology, investigation, and writing–review and editing

Giuditta Spagni, M.D.: methodology, investigation, and writing–review and editing

Sarah Hamilton: investigation and writing–review and editing

Takshaka Patel, B.S., B.A.: investigation, writing–original draft, and writing–review and editing

Nurlan Abdukadyrov, B.S.: formal analysis and writing–review and editing

Yushen Dong, B.S.: formal analysis and writing–review and editing

Antonio Gangemi, M.D., F.A.C.S, F.A.S.M.B.S.: conceptualization, supervision, funding acquisition, methodology, and writing–review and editing

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Russel, S.M., Valle, V., Spagni, G. et al. Physiologic Mechanisms of Type II Diabetes Mellitus Remission Following Bariatric Surgery: a Meta-analysis and Clinical Implications. J Gastrointest Surg 24, 728–741 (2020). https://doi.org/10.1007/s11605-019-04508-2

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