Lene Ring Madsen - Effect of gastric bypass surgery on diabetic status and microvascular complications in obese T2D patients

The prevalence of Type 2 diabetes mellitus (T2DM) is increasing in Denmark as well as worldwide. The obesity epidemic is one of the main drivers behind this development. Since conventional obesity treatments are seldom long-term successful, focus has turned to surgical treatments of obesity and T2DM. One of the most common bariatric procedures, Roux-en-Y gastric bypass surgery (RYGB), does not only result in large, sustained weight loss, but also appears to substantially improve obesity-related co-morbidities including T2DM.

While the immediate diabetes remission observed after RYGB may be owing to changes in gut hormones, profound weight loss seems to contribute to maintenance of remission. Recently, the focus has turned towards changes in gut microbiota and bile acids, following bariatric surgery, as mechanisms altering both insulin sensitivity and insulin resistance leading to diabetes remission.

Furthermore, age, gender, duration and severity of T2DM before RYGB, pre-surgery body mass index (BMI), and the size and speed of weight loss after RYGB, may influence post-surgical diabetes state.

Improved glucose regulation after RYGB seems to lead to reduction in diabetic micro- and macrovascular complications. On the other hand, immediate reduction of glucose levels (as seen with RYGB) in especially poorly regulated diabetic patients may have negative effects on some microvascular complications.

By combining registry-based and clinical follow-up studies, we aim investigate the long-term consequences of RYGB on diabetes status and microvascular complications. We aim to identify predictors of diabetes state and microvascular complications after RYGB. Finally, we aim to provide insight into factors influencing glucose-insulin homeostasis after RYGB, including altered microbiota diversity and bile acid levels. Through this project, we hope to obtain a deeper understanding of bariatric surgery enabling us to offer future patients individualized treatment options.