Royce P Vincent
King’s College Hospital NHS Foundation Trust | UK
Title: The role of bile acids in remission of type 2 diabetes after metabolic surgery
Biography
Biography: Royce P Vincent
Abstract
Type 2 diabetes is a pandemic afflicting more than 400 million people, with estimates of 650 million cases by 2040. Even with significant advances in pharmaceutical agents recently shown to reduce cardiovascular events, many patients with diabetes fail to achieve glycaemic treatment goals required to reduce micro and macrovascular complications. Metabolic surgery (bariatric surgery) is currently the most effective treatment to achieve significant and sustained weight loss in morbid obesity. There is now growing evidence of long-term remission of type 2 diabetes after metabolic surgery hence, the second Diabetes Surgery Summit (DSS-II), an international consensus conference, developed global guidelines that recommend inclusion of metabolic surgery among interventions for selected patients with type 2 diabetes and obesity. These recommendations have now been endorsed by more than 50 organisations worldwide, including major national and international diabetes and surgical societies. However, the pathophysiology of improved glucose metabolism after metabolic surgery remains poorly understood. Bile acid pool and composition are altered following certain metabolic surgeries. Thus, bile acids have emerged as a potential contributor to the improved glycaemic control after the procedures. Bile acids are the main component of human bile and have traditionally been considered mediators of lipid absorption and cholesterol metabolism, facilitated by their amphipathic nature. In recent years the discovery that specific bile acids differentially activate the G protein-coupled membrane receptor (TGR5) and the nuclear receptor, farnesoid X receptor (FXR), has identified bile acids as complex metabolic molecules that play a role in numerous pathways. This session will provide an overview of our current understanding of the interplay between bile acids and incretin (gut) hormones, the laboratory analysis of bile acids and its potential role in improving glycaemic control and remission of type 2 diabetes.