Potential of Surgery for Curing Type 2 Diabetes Mellitus

Francesco Rubino, MD, Michel Gagner, MD, FACS, FRCSC

Disclosures

Annals of Surgery. 2002;236(5) 

In This Article

Effect of Morbid Obesity Surgery on Gastrointestinal Hormones

The hypothesis that the effect of GBP and BPD on diabetes is mediated by a change in the pattern of secretion of gastrointestinal hormones is supported by other evidence. GBP increases the enteroglucagon[32,33] and gastroinhibitory peptide[34] response to oral glucose, increases insulin-like growth factor 1 levels (IGF-1),[35] and lowers plasma leptin levels in diabetic and nondiabetic morbidly obese patients.[25] Postprandial reduction of pancreatic polypeptide has also been documented.[33] Biliopancreatic diversion reduced leptin levels before weight loss occurred[36] and increased the enteroglucagon response to glucose test.[37] Decreased plasma lipid levels have also been reported after biliopancreatic diversion.[38] High levels of plasma glucagon-like peptide 1 have been reported after jejunoileal bypass,[39] and this is thought to play a role in the mechanism of diabetes control after bariatric surgeries.[40] Certainly, the lack of knowledge about the exact pathophysiologic mechanisms that lead to diabetes does not allow us to ascertain which of these changes can explain the "antidiabetic" effect of GBP and BPD.

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