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Bariatric surgery and obesity: influence on the incretins

Abstract

The gut hormone incretins have an important physiological role in meal-related insulin release and post-prandial glucose control. In addition to weight loss, the incretin hormones have a role in glucose control after bariatric surgery. The release of incretins, and specifically of glucagon-like peptide (GLP)-1, in response to the ingestion of nutrients, is greatly enhanced after gastric bypass (RYGBP). The rapid transit of food from the gastric pouch to the distal ileum is responsible for the greater GLP-1 release after RYGBP. The incretin effect on insulin secretion, or the greater insulin response to oral glucose compared to an isoglycemic intravenous glucose challenge, is severely impaired in patients with type 2 diabetes, but is recovered rapidly after RYGBP. The improvement in insulin secretion rate and β-cell sensitivity to oral glucose after RYGBP is mediated by endogenous GLP-1, and is abolished by exendin 9–39, a specific GLP-1 receptor antagonist. While calorie restriction and weight loss have major effects on the rapid and sustained improvement of fasted glucose metabolism, the enhanced incretin effect is a key player in post-prandial glucose control after RYGBP.

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Acknowledgements

Some of the work discussed here was funded by grants from the American Diabetes Association CR-7-05 CR-18, National Institutes of Health (R01-DK067561, P30-DK26687, P30-DK063608), the National Center for Advancing Translational Sciences, through Grant Number UL1 TR000040. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Publication of this article was sponsored by the Université Laval’s Research Chair in Obesity in an effort to inform the public on the causes, consequences, treatments, and prevention of obesity. BL is the recipient of one Investigator-initiated grant from Merck. However, data referred to in this review are not related to this source of funding. BL has received grant support from the National Institutes of Health and the American Heart Association.

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Laferrère, B. Bariatric surgery and obesity: influence on the incretins. Int J Obes Supp 6 (Suppl 1), S32–S36 (2016). https://doi.org/10.1038/ijosup.2016.8

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