Pathophysiological basis of endocrine metabolic modifications after bariatric surgery in type 2 diabetes
DOI:
https://doi.org/10.47196/diab.v50i3.44Keywords:
bariatric surgery, obesity, gastric bypass, diabetes mellitusAbstract
The long-term efficacy of therapeutic interventions have often failed to achieve the objectives and reduction of cardiovascular risk or chronic complications when diabetes mellitus type 2 (DM2) is associated with morbid obesity.
Emerging data postulate bariatric surgery as an effective treatment for obesity and its comorbidities.
The aim of this study is to conduct a research about this new DM2 therapeutic alternative, analyzing from the pathophysiology until the predictors of success and failure of
postsurgical results.
Postsurgical gut reorganization generates hormonal changes, modifications in bile acids, nutrient sensing, incretins, antiincretinas and gut microbioma; whose role is key since they are responsible for the effects in glucose homeostasis. However, the physiology and molecular mechanisms underlying are not still fully understood. Numerous short and medium term randomized clinical trials have proved that
through metabolic surgery an excellent glycemic control can be achieved thus reducing cardiovascular risk factors and mortality. Although further studies are needed to demonstrate long-term benefits there is enough evidence supporting their inclusion among interventions against DM2.
A better understanding of this constellation of factors involved in glucose homeostasis opens the way to potential therapeutic targets including specific drugs, less invasive techniques, optimization of surgical results and fundamentally
promote greater individualization of DM2 therapy.
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