ent insulinotropic polypeptide (GIP) [6] and that the restoration of a more physiologic GI hormone profile brought about by bariatric procedures may contribute to the improvement of glucose homeostasis. Roux-en-Y gastric bypass (RYGB), one of the most widely performed bariatric techniques, creates a gastrojejunal anastomosis so that ingested food moves to the distal small intestine bypassing the duodenum and the proximal jejunum. For these characteristics, it is considered a mixed-malabsorptive procedure. RYGB has proven its clinical efficacy in obese patients with type 2 diabetes for more than 30 years, with a diabetes remission of ~75 % [1]. Vertical sleeve gastrectomy (VSG) is a more recent procedure that involves the excision of most of the stomach while maintaining intestinal anatomy. It is considered a merely restrictive procedure although it is associated with marked reduction of plasma ghrelin concentrations due to the removal of the gastric fundus. VSG results in remarkable weight loss and metabolic improvement, reaching a rate of T2DM
Introduction
▼The increasing epidemic of obesity and type 2 diabetes (T2DM) is long recognized as a major healthcare problem. Bariatric surgery has emerged as the most successful therapeutic option for morbid obesity, since it results in remarkable and sustained weight loss and a dramatic improvement of glucose control in patients with T2DM [1]. The improvement/resolution of T2DM is associated with the extent of weight loss and the type of surgery ranging from 55 % after restrictive procedures to 95 % after malabsorptive interventions [2]. The beneficial effects on glucose metabolism occur early after surgery, before any substantial weight loss, suggesting a role of weight loss-independent mechanisms, possibly related to changes in gastrointestinal (GI) hormones in response to ingested nutrients [3][4][5]. There is now ample evidence that both obesity and T2DM are associated with impaired secretion/action of GI hormones, namely glucagon-like peptide 1 (GLP-1) and glucose-depend-