Mechanisms for surgical control of diabetes. An update

Diabetes control mechanisms through surgery are very complex. Caloric restriction plays an important role in the avoidance of type 2 diabetes. Obesity and fatty liver contribute to insulin resistance. Dr. Pattou talks about what else there is, other than weight loss, behind the surgery to control diabetes. When comparing sleeve gastrectomy (SG) with gastric bypass (RYGB), postprandial hyperglycemias seem to be more frequent in the first procedure. Gastrointestinal meal transport has been studied in pigs showing a hyperglycemic effect of bile when adding it to the clamped alimentary limb full of meal. So when bile is diverted from the meal, glucose is not fully absorbed. This effect is greater when creating a long biliary limb and a short common limb. Dr. Pattou and his team have followed up their type 2 diabetes patients who underwent a RYGB. The postprandial glucose control one year after surgery is a predictor of the clinical evolution of type 2 diabetes 5 years after surgery. So intestinal glucose transport is a very important mechanism of postprandial glucose control and it has an impact on type 2 diabetes, regardless of obesity.