3 years ago

The role of GLP-1 in the metabolic success bariatric surgery.

Darleen Sandoval, Chelsea R Hutch
Two of the most popular bariatric procedures, vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB), are commonly considered 'metabolic surgeries' because they are thought to impact metabolism in a weight loss-independent manner. In support of this, improvements in glucose homeostasis, insulin sensitivity, and even discontinuation of type 2 diabetes mellitus (T2DM) medication can occur before substantial postoperative weight loss. The mechanisms that underlie this effect are unknown. However, one of the common findings after VSG and RYGB in both animal models and in humans is the sharp postprandial rise in several gut peptides, including the incretin and satiety peptide, glucagon-like peptide-1 (GLP-1). The increase in endogenous GLP-1 signaling has been considered a primary pathway leading to post-surgical weight loss and improvements in glucose metabolism. However the degree to which GLP-1 and/or other gut peptides are responsible for the metabolic successes after bariatric surgery is continually debated. In this review, we discuss the mechanisms underlying the increase in GLP-1 as well as its potential role in the metabolic improvements after bariatric surgery including the resolution of T2DM. Understanding the role of changes in gut peptides, or lack thereof, will be crucial in understanding the critical factors necessary for the metabolic success of bariatric surgery.

Publisher URL: http://doi.org/10.1210/en.2017-00564

DOI: 10.1210/en.2017-00564

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