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Do Incretins Play a Role in the Remission of Type 2 Diabetes after Gastric Bypass Surgery: What are the Evidence?

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Abstract

Gastric bypass surgery (GBP), in addition to weight loss, results in dramatic remission of type 2 diabetes (T2DM). The mechanisms by which this remission occurs are unclear. Besides weight loss and caloric restriction, the changes in gut hormones that occur after GBP are increasingly gaining recognition as key players in glucose control. Incretins are gut peptides that stimulate insulin secretion postprandially; the levels of these hormones, particularly glucagon-like peptide-1, increase after GBP in response to nutrient stimulation. Whether these changes are causal to changes in glucose homeostasis remain to be determined. The purpose of this review is to assess the evidence on incretin changes and T2DM remission after GBP, and the possible mechanisms by which these changes occur. Our goals are to provide a thorough update on this field of research so that recommendations for future research and criteria for bariatric surgery can be evaluated.

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Abbreviations

T2DM:

type 2 diabetes mellitus

GBP:

gastric bypass surgery

GIP:

gastric inhibitory peptide-1

GLP-1:

glucagon-like peptide-1

DPP-IV:

dipeptidyl peptidase-IV

HbA1C:

hemoglobin A1C

VBG:

vertical banded gastroplasty

GB:

gastric banding

JIB:

jejunoileal bypass

BPD:

biliopancreatic diversion

BMI:

body mass index

OGTT:

oral glucose tolerance test

HGP:

hepatic glucose production

HOMA-IR:

homeostasis model assessment for insulin resistance

QUICKI:

quantitative insulin sensitivity check index

IVGTT:

intravenous glucose tolerance test

PYY:

peptide YY

IGT:

impaired glucose tolerance

FSIVGTT:

frequently sampled intravenous glucose tolerance test

AUC:

area under the curve

IT:

ileal interposition

GK:

Goto-Kakizaki

GJB:

gastrojejunal bypass

DJB:

duodenal-jejunal bypass

GJ:

gastrojejunostomy

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Acknowledgements

The authors would like to thank Ms. Baani Bawa, Ms. Adrienne O’Reilly, and Ms. Caroline Poryles for their assistance in manuscript preparation. This work was funded by the National Institute of Health training grant #DK07559.

Author Disclosures

M. Bose, B. Oliván, J. Teixeira, F.X. Pi-Sunyer, and B. Laferrère have no conflicts of interest.

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Bose, M., Oliván, B., Teixeira, J. et al. Do Incretins Play a Role in the Remission of Type 2 Diabetes after Gastric Bypass Surgery: What are the Evidence?. OBES SURG 19, 217–229 (2009). https://doi.org/10.1007/s11695-008-9696-3

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