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Review
. 2015;8(6):350-63.
doi: 10.1159/000441259. Epub 2015 Nov 20.

Metabolic Mechanisms in Obesity and Type 2 Diabetes: Insights from Bariatric/Metabolic Surgery

Adriana Florinela Cătoi  1 , Alina Pârvu, Adriana Mureşan, Luca Busetto
Affiliations
Review

Metabolic Mechanisms in Obesity and Type 2 Diabetes: Insights from Bariatric/Metabolic Surgery

Adriana Florinela Cătoi et al. Obes Facts. 2015.

Abstract

Obesity and the related diabetes epidemics represent a real concern worldwide. Bariatric/metabolic surgery emerged in last years as a valuable therapeutic option for obesity and related diseases, including type 2 diabetes mellitus (T2DM). The complicated network of mechanisms involved in obesity and T2DM have not completely defined yet. There is still a debate on which would be the first metabolic defect leading to metabolic deterioration: insulin resistance or hyperinsulinemia? Insight into the metabolic effects of bariatric/metabolic surgery has revealed that, beyond weight loss and food restriction, other mechanisms can be activated by the rearrangements of the gastrointestinal tract, such as the incretinic/anti-incretinic system, changes in bile acid composition and flow, and modifications of gut microbiota; all of them possibly involved in the remission of T2DM. The complete elucidation of these mechanisms will lead to a better understanding of the pathogenesis of this disease. Our aim was to review some of the metabolic mechanisms involved in the development of T2DM in obese patients as well as in the remission of this condition in patients submitted to bariatric/metabolic surgery.

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Figures

Fig. 1
Fig. 1
Muscle insulin resistance and the ‘twin cycle hypothesis’: roles of muscle, liver and pancreas in the occurrence of T2DM in obesity.
Fig. 2
Fig. 2
Characteristics of the more diffused bariatric/metabolic surgical procedures. From left to right: RYGB, sleeve gastrectomy, adjustable gastric banding, BPD with duodenal switch.
Fig. 3
Fig. 3
Mechanisms involved in obesity and T2DM and the effects of metabolic surgery.
See this image and copyright information in PMC

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