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Title: Mechanisms maintaining reduced appetite and normoglycaemia after metabolic surgery : the role of bile acids
Author: Pournaras, Dimitrios
ISNI:       0000 0004 2728 5579
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2012
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Obesity is becoming the healthcare epidemic of this century. Weight loss surgery is the only effective treatment for morbid obesity. Furthermore glycaemic control in type 2 diabetic patients is improved after metabolic surgery. Here I observed that with gastric bypass, type 2 diabetes can be improved and even rapidly put into a state of remission irrespective of weight loss. This is achieved via an improvement of both insulin resistance and insulin production. Reduced insulin resistance within the first week after surgery remains unexplained, but increased insulin production in the first week after surgery may be explained by the enhanced postprandial GLP-1 response. In addition, I demonstrate that bile flow changes lead to increased gut hormone response in animal models. Roux-en-Y gastric bypass in humans causes changes in bile flow leading to increased plasma bile acid concentrations. This phenomenon may explain the improved glycaemic control following gastric bypass. In conclusion I investigated the mechanism of diabetes remission after metabolic surgery and explored the role of gut hormones and bile acids in the changes in glucose homeostasis following metabolic surgery.
Supervisor: Bloom, Steve ; Le Roux, Carel Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral