Laferrère Blandine
Obesity Nutrition Research Center, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Endocrinol Nutr. 2012 Apr;59(4):254-60. doi: 10.1016/j.endonu.2012.01.010. Epub 2012 Mar 3.
Studies of patients going into diabetes remission after gastric bypass surgery have demonstrated the important role of the gut in glucose control. The improvement of type 2 diabetes after gastric bypass surgery occurs via weight dependent and weight independent mechanisms. The rapid improvement of glucose levels within days after the surgery, in relation to change of meal pattern, rapid nutrient transit, enhanced incretin release and improved incretin effect on insulin secretion, suggest mechanisms independent of weight loss. Alternatively, insulin sensitivity improves over time as a function of weight loss. The role of bile acids and microbiome in the metabolic improvement after bariatric surgery remains to be determined. While most patients after bariatric surgery experienced sustained weight loss and improved metabolism, small scale studies have shown weight regain and diabetes relapse, the mechanisms of which remain unknown.
对接受胃旁路手术后进入糖尿病缓解期的患者的研究表明，肠道在血糖控制中起着重要作用。胃旁路手术后2型糖尿病的改善通过体重依赖和体重非依赖机制发生。手术后数天内血糖水平的快速改善，与饮食模式的改变、营养物质快速通过、肠促胰岛素释放增加以及肠促胰岛素对胰岛素分泌的作用改善有关，提示存在与体重减轻无关的机制。另外，胰岛素敏感性会随着体重减轻而随时间改善。胆汁酸和微生物群在减肥手术后代谢改善中的作用仍有待确定。虽然大多数减肥手术后的患者体重持续减轻且代谢改善，但小规模研究显示体重会反弹且糖尿病会复发，其机制尚不清楚。
