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Bariatric surgery and T2DM improvement mechanisms: a mathematical model

BACKGROUND: Consensus exists that several bariatric surgery procedures produce a rapid improvement of glucose homeostasis in obese diabetic patients, improvement apparently uncorrelated with the degree of eventual weight loss after surgery. Several hypotheses have been suggested to account for these...

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Autores principales: Toghaw, Puntip, Matone, Alice, Lenbury, Yongwimon, De GAETANO, Andrea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586953/
https://www.ncbi.nlm.nih.gov/pubmed/22587410
http://dx.doi.org/10.1186/1742-4682-9-16
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author Toghaw, Puntip
Matone, Alice
Lenbury, Yongwimon
De GAETANO, Andrea
author_facet Toghaw, Puntip
Matone, Alice
Lenbury, Yongwimon
De GAETANO, Andrea
author_sort Toghaw, Puntip
collection PubMed
description BACKGROUND: Consensus exists that several bariatric surgery procedures produce a rapid improvement of glucose homeostasis in obese diabetic patients, improvement apparently uncorrelated with the degree of eventual weight loss after surgery. Several hypotheses have been suggested to account for these results: among these, the anti-incretin, the ghrelin and the lower-intestinal dumping hypotheses have been discussed in the literature. Since no clear-cut experimental results are so far available to confirm or disprove any of these hypotheses, in the present work a mathematical model of the glucose-insulin-incretin system has been built, capable of expressing these three postulated mechanisms. The model has been populated with critically evaluated parameter values from the literature, and simulations under the three scenarios have been compared. RESULTS: The modeling results seem to indicate that the suppression of ghrelin release is unlikely to determine major changes in short-term glucose control. The possible existence of an anti-incretin hormone would be supported if an experimental increase of GIP concentrations were evident post-surgery. Given that, on the contrary, collected evidence suggests that GIP concentrations decrease post-surgery, the lower-intestinal dumping hypothesis would seem to describe the mechanism most likely to produce the observed normalization of Type 2 Diabetes Mellitus (T2DM) after bariatric surgery. CONCLUSIONS: The proposed model can help discriminate among competing hypotheses in a context where definitive data are not available and mechanisms are still not clear.
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spelling pubmed-35869532013-03-08 Bariatric surgery and T2DM improvement mechanisms: a mathematical model Toghaw, Puntip Matone, Alice Lenbury, Yongwimon De GAETANO, Andrea Theor Biol Med Model Research BACKGROUND: Consensus exists that several bariatric surgery procedures produce a rapid improvement of glucose homeostasis in obese diabetic patients, improvement apparently uncorrelated with the degree of eventual weight loss after surgery. Several hypotheses have been suggested to account for these results: among these, the anti-incretin, the ghrelin and the lower-intestinal dumping hypotheses have been discussed in the literature. Since no clear-cut experimental results are so far available to confirm or disprove any of these hypotheses, in the present work a mathematical model of the glucose-insulin-incretin system has been built, capable of expressing these three postulated mechanisms. The model has been populated with critically evaluated parameter values from the literature, and simulations under the three scenarios have been compared. RESULTS: The modeling results seem to indicate that the suppression of ghrelin release is unlikely to determine major changes in short-term glucose control. The possible existence of an anti-incretin hormone would be supported if an experimental increase of GIP concentrations were evident post-surgery. Given that, on the contrary, collected evidence suggests that GIP concentrations decrease post-surgery, the lower-intestinal dumping hypothesis would seem to describe the mechanism most likely to produce the observed normalization of Type 2 Diabetes Mellitus (T2DM) after bariatric surgery. CONCLUSIONS: The proposed model can help discriminate among competing hypotheses in a context where definitive data are not available and mechanisms are still not clear. BioMed Central 2012-05-15 /pmc/articles/PMC3586953/ /pubmed/22587410 http://dx.doi.org/10.1186/1742-4682-9-16 Text en Copyright ©2012 Toghaw et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Toghaw, Puntip
Matone, Alice
Lenbury, Yongwimon
De GAETANO, Andrea
Bariatric surgery and T2DM improvement mechanisms: a mathematical model
title Bariatric surgery and T2DM improvement mechanisms: a mathematical model
title_full Bariatric surgery and T2DM improvement mechanisms: a mathematical model
title_fullStr Bariatric surgery and T2DM improvement mechanisms: a mathematical model
title_full_unstemmed Bariatric surgery and T2DM improvement mechanisms: a mathematical model
title_short Bariatric surgery and T2DM improvement mechanisms: a mathematical model
title_sort bariatric surgery and t2dm improvement mechanisms: a mathematical model
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586953/
https://www.ncbi.nlm.nih.gov/pubmed/22587410
http://dx.doi.org/10.1186/1742-4682-9-16
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