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Scientists have found the factor which puts Type 2 diabetes into remission following bariatric surgery, according to research published recently in Cell Reports. 

Bariatric surgery can be effective at putting Type 2 diabetes into remission, and the effects are often seen almost immediately post-surgery, long before the patient loses any significant weight.

Role of key gut hormone PYY identified 

Researchers funded by Diabetes UK at the University of Oxford, together with colleagues in Norway, have identified the role of a key gut hormone called PYY in restoring normal blood glucose levels in people with Type 2 diabetes following bariatric surgery.
  
During experiments in the laboratory, the team found that bariatric surgery reverts islets (regions of the pancreas that secrete hormones) back into working order.
 
The surgery brought the function of both alpha and beta cells within the islets back to normal: beta cells secrete the hormone insulin and alpha cells secrete the hormone glucagon.
 
Dr Reshma Ramracheya, lead Diabetes UK researcher based at the University of Oxford, explained, “Research has mostly focused on the importance of beta cells and insulin secretion in Type 2 diabetes, but that’s just part of the story. The fact that alpha cells – and glucagon secretion – are also affected goes some way to completing the equation.”

The team initially considered that a gut hormone called GLP-1 was the driving factor of the beneficial effects of bariatric surgery. However, a different gut hormone, called PYY, was found at higher levels in the blood after the surgery. When they tested this further in the lab using diabetic islets, they found that long-term treatment with PYY could restore the faulty islet function.
 
These findings may lead to the development of therapies that can put Type 2 diabetes into remission without the need for surgery.

Blood being taken from people who have had bariatric surgery

The team are now looking to find out how PYY improves the function of islets and whether blood taken from people with Type 2 diabetes who have had bariatric surgery can improve the function of islets in the lab.  

Dr Ramracheya said, “We’re now looking at how we can translate these findings into a treatment strategy for Type 2 diabetes. PYY is an obvious candidate, but we need to wait and see if the effects can be replicated long-term with a synthetic version of PYY.” 

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said, “Type 2 diabetes affects over 3.6 million people in the UK, and we need to find effective ways to both prevent the condition and reverse it in those that are living with Type 2 diabetes now. While bariatric surgery can be successful for some people with Type 2 diabetes, it’s not a widely accessible treatment option and we don’t fully understand how it works. Dr Ramracheya’s work provides a vital piece of the puzzle, and represents a very exciting step forwards toward the development of drugs that can put Type 2 diabetes into remission.”

View research: http://www.cell.com/cell-reports/pdf/S2211-1247(16)30368-0.pdf