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Review
. 2023 Feb 15:14:1031610.
doi: 10.3389/fendo.2023.1031610. eCollection 2023.

Bariatric Surgery: Targeting pancreatic β cells to treat type II diabetes

Tiantong Liu  1   2 , Xi Zou  1   3 , Rexiati Ruze  1   3 , Qiang Xu  1
Affiliations
Review

Bariatric Surgery: Targeting pancreatic β cells to treat type II diabetes

Tiantong Liu et al. Front Endocrinol (Lausanne). .

Abstract

Pancreatic β-cell function impairment and insulin resistance are central to the development of obesity-related type 2 diabetes mellitus (T2DM). Bariatric surgery (BS) is a practical treatment approach to treat morbid obesity and achieve lasting T2DM remission. Traditionally, sustained postoperative glycemic control was considered a direct result of decreased nutrient intake and weight loss. However, mounting evidence in recent years implicated a weight-independent mechanism that involves pancreatic islet reconstruction and improved β-cell function. In this article, we summarize the role of β-cell in the pathogenesis of T2DM, review recent research progress focusing on the impact of Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) on pancreatic β-cell pathophysiology, and finally discuss therapeutics that have the potential to assist in the treatment effect of surgery and prevent T2D relapse.

Keywords: Roux-en-Y gastric bypass; bariatric surgery; islet regeneration; type II diabetes mellitus; vertical sleeve gastrectomy; β-cell.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
A diagram of how vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) are performed. (A) In the RYGB procedure, the upper gastrointestinal tract is transected from near the gastric fundus and the jejunum to form a small gastric pouch. The stomach remnant and the duodenum and proximal jejunum are bypassed and attached to the mid-jejunum through a jejunal-jejunal anastomosis. Another gastro-jejunal anastomosis allows the connection of the gastric pouch and distal jejunum. (B) In VSG, most of the stomach is resected along the greater curvature while the remnant stomach forms a sleeve structure that greatly decreases the accommodative capacity and increases the chyme’s diversion rate.
Figure 2
Figure 2
A comparison between two most commonly performed bariatric procedures.
Figure 3
Figure 3
Physiological effects of crucial hormones that are altered after bariatric surgery. GLP-1 and PYY are gut-secreted hormones with anti-obesity and antidiabetic actions. The passage of food can stimulate both hormones through the gastrointestinal tract. Ghrelin and leptin are reduced after bariatric surgery. Ghrelin induces energy storage in the form of fat by promoting adipose tissue deposition and fatty acid oxidation, reducing energy expenditure, and blocking insulin secretion. Leptin has an antagonistic effect on ghrelin. PYY, Peptide YY. GLP-1, glucagon-like peptide 1. Dashed arrowhead, hormone secretion. Blue arrowhead, inhibitory effect. Red arrowhead, stimulatory effect.
See this image and copyright information in PMC

References

    1. Blüher M. Obesity: Global epidemiology and pathogenesis. Nat Rev Endocrinol (2019) 15(5):288–98. doi: 10.1038/s41574-019-0176-8 - DOI - PubMed
    1. Magkos F, Hjorth MF, Astrup A. Diet and exercise in the prevention and treatment of type 2 diabetes mellitus. Nat Rev Endocrinol (2020) 16(10):545–55. doi: 10.1038/s41574-020-0381-5 - DOI - PubMed
    1. Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: State of the art. Nat Rev Gastroenterol Hepatol (2017) 14(3):160–9. doi: 10.1038/nrgastro.2016.170 - DOI - PubMed
    1. Chang S-H, Stoll CRT, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: An updated systematic review and meta-analysis, 2003-2012. JAMA Surg (2014) 149(3):275–87. doi: 10.1001/jamasurg.2013.3654 - DOI - PMC - PubMed
    1. Carlsson LMS, Peltonen M, Ahlin S, Anveden Å, Bouchard C, Carlsson B, et al. . Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med (2012) 367(8):695–704. doi: 10.1056/NEJMoa1112082 - DOI - PubMed

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