الفهرس 
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Abstract
Bariatric surgery not only causes weight loss, it also leads to normalization of blood sugars in over 80% of his diabetic patients. Initially, the normalization of blood sugars was thought to be directly caused by the weight loss. However, it has subsequently been noted that blood glucose control improves immediately following the surgery, prior to any significant weight loss. Most remarkably, many obese diabetic patients who undergo bariatric surgeries are relieved of their anti-diabetic medications in a matter of days.
Diabetes remission does not occur with similar degrees of caloric reduction following other surgical procedures, nor with liposuction or surgical resection of omental fat. There are potential mechanisms beyond weight loss by which bariatric surgeryleads to diabetes improvements, but the relative contribution of insulin sensitivity, b-cell function, and other potentially novel mechanisms to improved metabolism following bariatric surgeryremain incompletely understood.
The improvement of peripheral insulin sensitivity appears to be weight dependent, while hepatic insulin sensitivity seems to be a function of caloric restriction. However, alterations in pancreatic function are reflected in the robust postprandial insulin secretion profile, and appear to be a direct result of bariatric surgery.
The observed remission of type 2 diabetes before any significant weight loss has taken place suggests that the operation itself, including rerouting of ingested food (bypassing significant parts of the small intestine) and digestive fluids, changes handling of nutrients. In support of this theory, the purely restrictive procedure of gastric banding, which gives rise to long-term metabolic advantages associated with weight loss, has no acute effect on postprandial glucose metabolism (or gut hormones).