Bariatric and metabolic surgery improves glycolipid metabolism via bile acid regulation and intestinal barrier repair in T2DM patients.

BACKGROUND

To observe the changes in bile acid synthase activity, conjugation enzyme gene and intestinal mucosal barrier function (D-LA, Zonulin, MFG-E8) in patients with type 2 diabetes mellitus (T2DM) after bariatric and metabolic surgery (BMS), and to provide an objective opinion on the clinical optimisation of BMS.

METHODS

127 patients with T2DM who had received BMS treatment at our hospital from October 2023 to August 2024 were included in the study, and weight loss glucose-lipid metabolism was detected before surgery and 6 months after surgery. Furthermore, the study quantified the expression levels of key enzymes involved in bile acid synthesis and conjugation (CYP7A1, CYP27A1, FXR, FGF19) and markers indicative of intestinal mucosal barrier function (D-LA, Zonulin, MFG-E8).

RESULTS

After BMS, the patient's weight was significantly reduced, and glucolipid metabolism was significantly improved (P< 0.05). In addition, CYP7A1 was decreased, and FXR and FGF19 were elevated in patients after surgery (P < 0.05). Regarding the intestinal mucosal barrier function, D-LA and Zonulin were reduced in patients after surgery (P< 0.05). MFG-E8 was not significantly altered.

CONCLUSIONS

BMS can effectively improve glucose-lipid metabolism and reduce body weight in T2DM patients, and its mechanism is related to regulating bile acid metabolism and promoting the recovery of intestinal barrier function.