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Review
. 2014;14(5):481.
doi: 10.1007/s11892-014-0481-5.

The sum of many parts: potential mechanisms for improvement in glucose homeostasis after bariatric surgery

Kim T Nguyen  1 , Judith Korner
Affiliations
Review

The sum of many parts: potential mechanisms for improvement in glucose homeostasis after bariatric surgery

Kim T Nguyen et al. Curr Diab Rep. 2014.

Abstract

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.

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Conflict of interest statement

Conflict of Interest K. T. Nguyen declares that she has no conflict of interest. J. Korner has been a consultant for the Federal Trade Commission; has given expert testimony for the Office of Professional Misconduct; has received grant support from Covidien; and has pending grant support as well as travel/accommodations expenses covered or reimbursed from Novo Nordisk.

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