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      Evidence of unrestrained beta-cell proliferation and neogenesis in a patient with hyperinsulinemic hypoglycemia after gastric bypass surgery

      1 , 2 , 1

      Islets

      Informa UK Limited

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          Most cited references 12

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          Behavioral treatment of obesity.

          This review has shown that behavioral treatment is effective in inducing a 10% weight loss, which is sufficient to significantly improve health. Weight loss maintenance is challenging for most patients. Long-term outcomes have the potential to be improved through various methods including prolonging contact between patients and providers (either in the clinic or via Internet or telephone), facilitating high amounts of physical activity, or combining lifestyle modification with pharmacotherapy. Innovative programs also are being developed to disseminate behavioral approaches beyond traditional academic settings.
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            Minireview: Hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery.

            Bariatric surgery is the most effective available treatment for obesity. The most frequently performed operation, Roux-en-Y gastric bypass (RYGB), causes profound weight loss and ameliorates obesity-related comorbid conditions, especially type 2 diabetes mellitus (T2DM). Approximately 84% of diabetic patients experience complete remission of T2DM after undergoing RYGB, often before significant weight reduction. The rapid time course and disproportional degree of T2DM improvement after RYGB compared with equivalent weight loss from other interventions suggest surgery-specific, weight-independent effects on glucose homeostasis. Potential mechanisms underlying the direct antidiabetic impact of RYGB include enhanced nutrient stimulation of lower intestinal hormones (e.g. glucagon-like peptide-1), altered physiology from excluding ingested nutrients from the upper intestine, compromised ghrelin secretion, modulations of intestinal nutrient sensing and regulation of insulin sensitivity, and other changes yet to be fully characterized. Research aimed at determining the relative importance of these effects and identifying additional mechanisms promises not only to improve surgical design but also to identify novel targets for diabetes medications.
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              Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased beta-cell turnover.

              The purpose of this study was to establish whether hypoglycemia after gastric bypass surgery (GBS) for morbid obesity is due to increased fractional beta-cell area or inappropriately increased insulin secretion. We examined pancreata obtained at partial pancreatectomy from 6 patients with post-GBS hypoglycemia and compared these with 31 pancreata from obese subjects and 16 pancreata from lean control subjects obtained at autopsy. We addressed the following questions. In patients with post-GBS hypoglycemia, is beta-cell area increased and is beta-cell formation increased or beta-cell apoptosis decreased? We report that in patients with post-GBS hypoglycemia, beta-cell area was not increased compared with that in obese or even lean control subjects. Consistent with this finding, there was no evidence of increased beta-cell formation (islet neogenesis and beta-cell replication) or decreased beta-cell loss in patients with post-GBS hypoglycemia. In control subjects, mean beta-cell nuclear diameter correlated with BMI (r(2) = 0.79, P < 0.001). In patients with post-GBS hypoglycemia, beta-cell nuclear diameter was increased (P < 0.001) compared with that for BMI in matched control subjects but was appropriate for BMI before surgery. We conclude that post-GBS hypoglycemia is not due to increases in beta-cell mass or formation. Rather, postprandial hypoglycemia after GBS is due to a combination of gastric dumping and inappropriately increased insulin secretion, either as a failure to adaptively decrease insulin secretion after GBS or as an acquired phenomenon.
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                Author and article information

                Journal
                Islets
                Islets
                Informa UK Limited
                1938-2014
                1938-2022
                December 06 2018
                November 02 2018
                October 12 2018
                November 02 2018
                : 10
                : 6
                : 213-220
                Affiliations
                [1 ] Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
                [2 ] Department of Nutrition, Université de Montréal, Montréal, QC, Canada
                Article
                10.1080/19382014.2018.1513748
                © 2018

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