Metabolic Surgery and T2DM: Post-Surgery Hormone Profile in Glucose Metabolism

Abstract

Obesity is a critical factor to enhance the risk of T2DM and other comorbidities. Diabesity a metabolic disorder due to obesity and insulin-resistance (IR), is a global health concern.T2DM a condition of chronic decreased insulin sensitivity or insulin resistance (IR) and loss of pancreatic β-cells resulting in poor insulin synthesis. Lipotoxicity delivers negative impact on β-cell function and adiposity cause inflammatory conditions contributing to impair insulin signaling and eventual IR. Metabolic surgery is bariatric surgery to modulate GI hormones to derive glucose homeostasis in T2DM subjects through anatomical alteration. Metabolic surgery exerts its physiological benefits for proper glucose homeostasis and is being exploited to address condition of obesity with T2DM globally. Post metabolic surgery mediated T2DM remission is weight independent indicating role of potential hormone-modulation. Elevated circulation of free fatty acids from adipose tissue in obese patients may lead to β-cells dysfunction. Oral hypoglycemic drugs and insulin treatment are of a limited advantage in diabesity as they tend to increase body weight. This challenge has driven medical fraternity to exploit the bariatric surgery as metabolic surgery in obese patients with T2DM. Metabolic surgeries are either restrictive or gastrointestinal diversion procedures. Adiponectin an adipokine secreted by adipocytes though not a direct gut hormone acts as insulin sensitizer. Gastro-intestinal tract (GIT) hormones like GLP-1, peptide YY, oxyntomodulin, obestatin, ghrelin, and cholecystokinin play crucial role in the energy homeostasis and glucose metabolism. Considering the role of altered hormone profile metabolic surgery has drawn attention in the management of T2DM in obese patients.