Internal medicine

Carbohydrate metabolism

Sleeve gastrectomy

Obesity

Diabetes mellitus

Endocrinology

Surgery

Adipose tissue

Type 2 diabetes

Insulin resistance

Type 2 Diabetes Mellitus

Gastric bypass

Weight loss

Medicine

Nature Reviews Endocrinology

Although promising therapeutics are in the pipeline, bariatric surgery (also known as metabolic surgery) remains our most effective strategy for the treatment of obesity and type 2 diabetes mellitus (T2DM). Of the many available options, Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are currently the most widely used procedures. RYGB and VSG have very different anatomical restructuring but both surgeries are effective, to varying degrees, at inducing weight loss and T2DM remission. Both weight loss-dependent and weight loss-independent alterations in multiple tissues (such as the intestine, liver, pancreas, adipose tissue and skeletal muscle) yield net improvements in insulin resistance, insulin secretion and insulin-independent glucose metabolism. In a subset of patients, post-bariatric hypoglycaemia can develop months to years after surgery, potentially reflecting the extreme effects of potent glucose reduction after surgery. This Review addresses the effects of bariatric surgery on glucose regulation and the potential mechanisms responsible for both the resolution of T2DM and the induction of hypoglycaemia. Bariatric surgery induces weight loss and can trigger remission of type 2 diabetes mellitus (T2DM) but may also lead to post-bariatric hypoglycaemia. This Review examines surgery-induced changes in glucose regulation and the potential mechanisms responsible for the resolution of T2DM and induction of hypoglycaemia.

Glucose metabolism after bariatric surgery: implications for T2DM remission and hypoglycaemia