Gut as an emerging organ for the treatment of diabetes: focus on mechanism of action of bariatric and endoscopic interventions

Increasing worldwide prevalence of type 2 diabetes mellitus and its accompanying pathologies such as obesity, arterial hypertension and dyslipidemia represents one of the most important challenges of current medicine. Despite intensive efforts, high percentage of patients with type 2 diabetes does n...

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Published inJournal of endocrinology Vol. 237; no. 1; pp. R1 - R17
Main Authors Haluzík, Martin, Kratochvílová, Helena, Haluzíková, Denisa, Mráz, Miloš
Format Journal Article
LanguageEnglish
Published England Bioscientifica Ltd 01.04.2018
Subjects
Review
endoscopic treatment
duodenum exclusion
type 2 diabetes
bariatric surgery
mechanism
Online AccessGet full text
ISSN0022-0795
1479-6805
1479-6805
DOI10.1530/JOE-17-0438

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Abstract Increasing worldwide prevalence of type 2 diabetes mellitus and its accompanying pathologies such as obesity, arterial hypertension and dyslipidemia represents one of the most important challenges of current medicine. Despite intensive efforts, high percentage of patients with type 2 diabetes does not achieve treatment goals and struggle with increasing body weight and poor glucose control. While novel classes of antidiabetic medications such as incretin-based therapies and gliflozins have some favorable characteristics compared to older antidiabetics, the only therapeutic option shown to substantially modify the progression of diabetes or to achieve its remission is bariatric surgery. Its efficacy in the treatment of diabetes is well established, but the exact underlying modes of action are still only partially described. They include restriction of food amount, enhanced passage of chymus into distal part of small intestine with subsequent modification of gastrointestinal hormones and bile acids secretion, neural mechanisms, changes in gut microbiota and many other possible mechanisms underscoring the importance of the gut in the regulation of glucose metabolism. In addition to bariatric surgery, less-invasive endoscopic methods based on the principles of bariatric surgery were introduced and showed promising results. This review highlights the role of the intestine in the regulation of glucose homeostasis focusing on the mechanisms of action of bariatric and especially endoscopic methods of the treatment of diabetes. A better understanding of these mechanisms may lead to less invasive endoscopic treatments of diabetes and obesity that may complement and widen current therapeutic options.
AbstractList Increasing worldwide prevalence of type 2 diabetes mellitus and its accompanying pathologies such as obesity, arterial hypertension and dyslipidemia represents one of the most important challenges of current medicine. Despite intensive efforts, high percentage of patients with type 2 diabetes does not achieve treatment goals and struggle with increasing body weight and poor glucose control. While novel classes of antidiabetic medications such as incretin-based therapies and gliflozins have some favorable characteristics compared to older antidiabetics, the only therapeutic option shown to substantially modify the progression of diabetes or to achieve its remission is bariatric surgery. Its efficacy in the treatment of diabetes is well established, but the exact underlying modes of action are still only partially described. They include restriction of food amount, enhanced passage of chymus into distal part of small intestine with subsequent modification of gastrointestinal hormones and bile acids secretion, neural mechanisms, changes in gut microbiota and many other possible mechanisms underscoring the importance of the gut in the regulation of glucose metabolism. In addition to bariatric surgery, less-invasive endoscopic methods based on the principles of bariatric surgery were introduced and showed promising results. This review highlights the role of the intestine in the regulation of glucose homeostasis focusing on the mechanisms of action of bariatric and especially endoscopic methods of the treatment of diabetes. A better understanding of these mechanisms may lead to less invasive endoscopic treatments of diabetes and obesity that may complement and widen current therapeutic options.
Increasing worldwide prevalence of type 2 diabetes mellitus and its accompanying pathologies such as obesity, arterial hypertension and dyslipidemia represents one of the most important challenges of current medicine. Despite intensive efforts, high percentage of patients with type 2 diabetes does not achieve treatment goals and struggle with increasing body weight and poor glucose control. While novel classes of antidiabetic medications such as incretin-based therapies and gliflozins have some favorable characteristics compared to older antidiabetics, the only therapeutic option shown to substantially modify the progression of diabetes or to achieve its remission is bariatric surgery. Its efficacy in the treatment of diabetes is well established, but the exact underlying modes of action are still only partially described. They include restriction of food amount, enhanced passage of chymus into distal part of small intestine with subsequent modification of gastrointestinal hormones and bile acids secretion, neural mechanisms, changes in gut microbiota and many other possible mechanisms underscoring the importance of the gut in the regulation of glucose metabolism. In addition to bariatric surgery, less-invasive endoscopic methods based on the principles of bariatric surgery were introduced and showed promising results. This review highlights the role of the intestine in the regulation of glucose homeostasis focusing on the mechanisms of action of bariatric and especially endoscopic methods of the treatment of diabetes. A better understanding of these mechanisms may lead to less invasive endoscopic treatments of diabetes and obesity that may complement and widen current therapeutic options.Increasing worldwide prevalence of type 2 diabetes mellitus and its accompanying pathologies such as obesity, arterial hypertension and dyslipidemia represents one of the most important challenges of current medicine. Despite intensive efforts, high percentage of patients with type 2 diabetes does not achieve treatment goals and struggle with increasing body weight and poor glucose control. While novel classes of antidiabetic medications such as incretin-based therapies and gliflozins have some favorable characteristics compared to older antidiabetics, the only therapeutic option shown to substantially modify the progression of diabetes or to achieve its remission is bariatric surgery. Its efficacy in the treatment of diabetes is well established, but the exact underlying modes of action are still only partially described. They include restriction of food amount, enhanced passage of chymus into distal part of small intestine with subsequent modification of gastrointestinal hormones and bile acids secretion, neural mechanisms, changes in gut microbiota and many other possible mechanisms underscoring the importance of the gut in the regulation of glucose metabolism. In addition to bariatric surgery, less-invasive endoscopic methods based on the principles of bariatric surgery were introduced and showed promising results. This review highlights the role of the intestine in the regulation of glucose homeostasis focusing on the mechanisms of action of bariatric and especially endoscopic methods of the treatment of diabetes. A better understanding of these mechanisms may lead to less invasive endoscopic treatments of diabetes and obesity that may complement and widen current therapeutic options.
Author Haluzík, Martin
Kratochvílová, Helena
Mráz, Miloš
Haluzíková, Denisa
AuthorAffiliation Department of Sports Medicine, General University Hospital, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
Department of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
AuthorAffiliation_xml – name: Department of Sports Medicine, General University Hospital, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
– name: Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
– name: Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
– name: Department of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
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  givenname: Martin
  surname: Haluzík
  fullname: Haluzík, Martin
  email: halm@ikem.cz
  organization: Department of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
– sequence: 2
  givenname: Helena
  surname: Kratochvílová
  fullname: Kratochvílová, Helena
  organization: Department of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
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  surname: Haluzíková
  fullname: Haluzíková, Denisa
  organization: Department of Sports Medicine, General University Hospital, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
– sequence: 4
  givenname: Miloš
  surname: Mráz
  fullname: Mráz, Miloš
  organization: Department of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic
BackLink https://www.ncbi.nlm.nih.gov/pubmed/29378901$$D View this record in MEDLINE/PubMed
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Keywords endoscopic treatment
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type 2 diabetes
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mechanism
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Snippet Increasing worldwide prevalence of type 2 diabetes mellitus and its accompanying pathologies such as obesity, arterial hypertension and dyslipidemia represents...
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Title Gut as an emerging organ for the treatment of diabetes: focus on mechanism of action of bariatric and endoscopic interventions
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