Marmoset Embryonic Stem Cells Forming Neurons

Another Reason GLP-1 Is Important for Obesity Care

Why does bariatric surgery have such a profound effect on diabetes? It’s more than you might expect simply from the effects on weight. A large portion of patients with diabetes and obesity have remissions after surgery. Even before they lose much weight. New research in Cell Reports this week points to GLP-1 secretion as a key factor.

Diabetes Remissions After Surgery

New research in Diabetologia offers perspective on the clinical benefits in a real world setting. Lene Madsen and colleagues studied the outcomes for 1,111 patients who had diabetes and underwent gastric bypass surgery in northern Denmark between 2006 and 2015. They compared them with a matched cohort of 1,074 patients not receiving surgery. They found that 74 percent of the surgery patients had a diabetes remission in the first 12 months after surgery. Five years after surgery, most of the patients who had a remission – 73 percent – were still in remission.

Older patients, patients who had a longer history of diabetes, and patients who required insulin were less likely to have a remission. In other words, earlier treatment seems to be better.

The Role of GLP-1

The research in Cell Reports is especially fascinating because it demonstrates that GLP-1 may be a major driver of the effect that surgery exerts to reverse diabetes. Through studies in mice and humans, researchers led by Pierre Larraufie showed that the both gastric bypass and gastric sleeve surgeries led to more secretion of GLP-1 in response to food. That’s because more of the nutrients reach the lower gut to stimulate that secretion. And in turn, GLP-1 stimulates more insulin secretion.

It’s worth noting that GLP-1 agonists like liraglutide, dulaglutide, and semaglutide exert their effects on diabetes and obesity by mimicking the actions of GLP-1 itself. Liraglutide is the only one of these currently indicated for both diabetes and obesity treatment.

The research team plans to build on these findings and more fully describe the physiological response to surgery. The interest in sorting this out is more than just academic. Senior author Fiona Gribble explains:

If you can work that out and make a therapy that mimics that, that is what everyone wants: an injectable or oral medication that could mimic the surgery and cause weight loss in people without the surgery.

Clearly, diabetes and obesity are physiological problems that behavioral strategies alone cannot solve. But the physiological changes that surgery brings are offering us some excellent clues for even better solutions than we have today.

Click here for the Masden study and here for further reporting on it. For the Larraufie study click here and then here for additional reporting.

Marmoset Embryonic Stem Cells Forming Neurons, photograph © Scott Vermilyea / NIH Image Gallery / flickr

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Month xx, 2019