Gastric Bypass and Diabetes: Past, Present and Future

Tse-I      Lee; Jui-Hung      Chen; Ting-Chia      Weng; Keong      Chong; Wei-Jei      Lee; Lee-Ming      Chuang

doi:10.2174/157339911797415611

Abstract

Context: Owing to the pathogenic role of insulin resistance and beta-cell dysfunction in type 2 diabetes, the clinical manifestation of this disease is extremely complex and is often associated with obesity. In recent years, Roux-en-Y gastric bypass (RYGB) surgery, which was originally developed to treat morbid obesity, has been found to have therapeutic potential for diabetes. However, the underlying mechanisms of the therapeutic application of this technique are not fully known.

Objective: This review describes the technique of RYGB, including the advantages and disadvantages of the procedure. The advantages include metabolic improvement, obesity resolution, and reduction in morbidity. The disadvantages include short-term perioperative complications and long-term nutritional disorders. Finally, we provide a review of the possible underlying mechanisms leading to the resolution of type 2 diabetes symptoms after the RYGB procedure.

Conclusions: While some complications are found after RYGB, there have also been reports showing a remarkable decrease in mortality, successful weight loss, and resolution of type 2 diabetes. The actual mechanism leading to diabetes resolution remains unknown. Gastric bypass surgery is certainly an effective method to increase remission rate in a subgroup of type 2 diabetes patients with morbid obesity.

Keywords: Roux-en-Y gastric bypass, Type 2 diabetes, Morbid obesity, Weight reduction, Incretins, Beta-cell dysfunction, Insulin, Microvascular complications, Diabetic nephropathy, Hyperglycemia