Metabolic Disease Research Center, Zhengzhou University Affiliated Zhengzhou Central Hospital, Zhengzhou 450007, China; Center for Advanced Medicine, College of Medicine, Zhengzhou University, Zhengzhou 450052, China; Research Center for Basic Medicine, Academy of Medical Sciences, Zhengzhou University, Zhengzhou 450052, China.
Department of Metabolic Surgery, Zhengzhou University Affiliated Zhengzhou Central Hospital, Zhengzhou 450007, China.
Trends Endocrinol Metab. 2023 Oct;34(10):590-600. doi: 10.1016/j.tem.2023.07.001. Epub 2023 Aug 11.
Bariatric surgery is a powerful therapy for type 2 diabetes in patients with obesity. The mechanism of insulin sensitization by surgery has been extensively investigated in weight loss-dependent and weight loss-independent conditions. However, a consensus remains to be established regarding the underlying mechanisms. Energy deficit induced by calorie restriction (CR), that occurs both before and after surgery, represents a unique physiological basis for insulin sensitization regardless of weight loss. In support, we integrate evidence in the literature to provide an energy-based view of insulin sensitization as follows: surgery improves insulin sensitivity through the energy deficit induced by CR, leading to correction of mitochondrial overload in multiple cell types; this then triggers functional reprogramming of relevant tissues leading to diabetes remission.
减重手术是肥胖 2 型糖尿病患者的有效治疗方法。手术通过减轻体重和不依赖于减轻体重的机制来增加胰岛素敏感性的机制已被广泛研究。然而，对于潜在机制仍未达成共识。热量限制（CR）引起的能量不足，无论是在手术前还是手术后都会发生，这代表了一种独特的生理基础，与体重减轻无关，可增强胰岛素敏感性。有证据表明，手术通过 CR 引起的能量不足改善胰岛素敏感性，导致多种细胞类型中线粒体过载的纠正；这继而触发相关组织的功能重新编程，从而导致糖尿病缓解。
