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Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass

Roux-en-Y gastric bypass (RYGB) greatly improves glycaemic control in morbidly obese patients with type 2 diabetes, in many even before significant weight loss. Understanding the responsible mechanisms may contribute to our knowledge of the pathophysiology of type 2 diabetes and help identify new dr... Full description

Journal Title: Diabetologia 2012-04-27, Vol.55 (7), p.1890-1901
Main Author: Dirksen, C
Other Authors: Jørgensen, N. B , Bojsen-Møller, K. N , Jacobsen, S. H , Hansen, D. L , Worm, D , Holst, J. J , Madsbad, S
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Berlin/Heidelberg: Springer-Verlag
ID: ISSN: 0012-186X
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title: Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass
format: Article
creator:
  • Dirksen, C
  • Jørgensen, N. B
  • Bojsen-Møller, K. N
  • Jacobsen, S. H
  • Hansen, D. L
  • Worm, D
  • Holst, J. J
  • Madsbad, S
subjects:
  • Biological and medical sciences
  • Blood Glucose - metabolism
  • Diabetes
  • Diabetes Mellitus, Type 2 - blood
  • Diabetes Mellitus, Type 2 - metabolism
  • Diabetes. Impaired glucose tolerance
  • Endocrine pancreas. Apud cells (diseases)
  • Endocrinopathies
  • Etiopathogenesis. Screening. Investigations. Target tissue resistance
  • Female
  • Gastric Bypass
  • Glucagon
  • Glucagon-Like Peptide 1 - blood
  • Glucose Tolerance Test
  • Human Physiology
  • Humans
  • Insulin Resistance
  • Insulin-Secreting Cells - metabolism
  • Internal Medicine
  • Male
  • Medical sciences
  • Medicine
  • Medicine & Public Health
  • Metabolic Diseases
  • Obesity
  • Obesity, Morbid - blood
  • Obesity, Morbid - surgery
  • Peptides
  • Review
  • Surgery
  • Time Factors
  • Treatment Outcome
  • Type 2 diabetes
ispartof: Diabetologia, 2012-04-27, Vol.55 (7), p.1890-1901
description: Roux-en-Y gastric bypass (RYGB) greatly improves glycaemic control in morbidly obese patients with type 2 diabetes, in many even before significant weight loss. Understanding the responsible mechanisms may contribute to our knowledge of the pathophysiology of type 2 diabetes and help identify new drug targets or improve surgical techniques. This review summarises the present knowledge based on pathophysiological studies published during the last decade. Taken together, two main mechanisms seem to be responsible for the early improvement in glycaemic control after RYGB: (1) an increase in hepatic insulin sensitivity induced, at least in part, by energy restriction and (2) improved beta cell function associated with an exaggerated postprandial glucagon-like peptide 1 secretion owing to the altered transit of nutrients. Later a weight loss induced improvement in peripheral insulin sensitivity follows.
language: eng
source:
identifier: ISSN: 0012-186X
fulltext: no_fulltext
issn:
  • 0012-186X
  • 1432-0428
url: Link


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creatorDirksen, C ; Jørgensen, N. B ; Bojsen-Møller, K. N ; Jacobsen, S. H ; Hansen, D. L ; Worm, D ; Holst, J. J ; Madsbad, S
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descriptionRoux-en-Y gastric bypass (RYGB) greatly improves glycaemic control in morbidly obese patients with type 2 diabetes, in many even before significant weight loss. Understanding the responsible mechanisms may contribute to our knowledge of the pathophysiology of type 2 diabetes and help identify new drug targets or improve surgical techniques. This review summarises the present knowledge based on pathophysiological studies published during the last decade. Taken together, two main mechanisms seem to be responsible for the early improvement in glycaemic control after RYGB: (1) an increase in hepatic insulin sensitivity induced, at least in part, by energy restriction and (2) improved beta cell function associated with an exaggerated postprandial glucagon-like peptide 1 secretion owing to the altered transit of nutrients. Later a weight loss induced improvement in peripheral insulin sensitivity follows.
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languageeng
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subjectBiological and medical sciences ; Blood Glucose - metabolism ; Diabetes ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - metabolism ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Gastric Bypass ; Glucagon ; Glucagon-Like Peptide 1 - blood ; Glucose Tolerance Test ; Human Physiology ; Humans ; Insulin Resistance ; Insulin-Secreting Cells - metabolism ; Internal Medicine ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Obesity ; Obesity, Morbid - blood ; Obesity, Morbid - surgery ; Peptides ; Review ; Surgery ; Time Factors ; Treatment Outcome ; Type 2 diabetes
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descriptionRoux-en-Y gastric bypass (RYGB) greatly improves glycaemic control in morbidly obese patients with type 2 diabetes, in many even before significant weight loss. Understanding the responsible mechanisms may contribute to our knowledge of the pathophysiology of type 2 diabetes and help identify new drug targets or improve surgical techniques. This review summarises the present knowledge based on pathophysiological studies published during the last decade. Taken together, two main mechanisms seem to be responsible for the early improvement in glycaemic control after RYGB: (1) an increase in hepatic insulin sensitivity induced, at least in part, by energy restriction and (2) improved beta cell function associated with an exaggerated postprandial glucagon-like peptide 1 secretion owing to the altered transit of nutrients. Later a weight loss induced improvement in peripheral insulin sensitivity follows.
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1Blood Glucose - metabolism
2Diabetes
3Diabetes Mellitus, Type 2 - blood
4Diabetes Mellitus, Type 2 - metabolism
5Diabetes. Impaired glucose tolerance
6Endocrine pancreas. Apud cells (diseases)
7Endocrinopathies
8Etiopathogenesis. Screening. Investigations. Target tissue resistance
9Female
10Gastric Bypass
11Glucagon
12Glucagon-Like Peptide 1 - blood
13Glucose Tolerance Test
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16Insulin Resistance
17Insulin-Secreting Cells - metabolism
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abstractRoux-en-Y gastric bypass (RYGB) greatly improves glycaemic control in morbidly obese patients with type 2 diabetes, in many even before significant weight loss. Understanding the responsible mechanisms may contribute to our knowledge of the pathophysiology of type 2 diabetes and help identify new drug targets or improve surgical techniques. This review summarises the present knowledge based on pathophysiological studies published during the last decade. Taken together, two main mechanisms seem to be responsible for the early improvement in glycaemic control after RYGB: (1) an increase in hepatic insulin sensitivity induced, at least in part, by energy restriction and (2) improved beta cell function associated with an exaggerated postprandial glucagon-like peptide 1 secretion owing to the altered transit of nutrients. Later a weight loss induced improvement in peripheral insulin sensitivity follows.
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