Emerging therapies in the treatment of ‘diabesity’: beyond GLP-1

Bariatric surgery has proven to be an effective means of treating ‘diabesity’: the combination of type 2 diabetes mellitus (T2DM) and obesity. The effects of surgery go beyond weight loss but reflect a complex alteration in secretion of gut hormones. Finding a pharmaceutical alternative that mimics the benefits of surgery without surgical complications has become the ‘holy grail’ of the twenty-first century. As knowledge of the multifaceted functions of gut hormones increases, a multitude of drugs that exploit these actions has emerged. In this review, we examine the current understanding of the mechanisms by which bariatric surgery improves diabesity. We also discuss the rapidly emerging role of glucagon-like peptide-1-based treatments as well as the potential for new therapeutics based on other gut hormones (e.g. oxyntomodulin, peptide YY, gastric inhibitory peptide, ghrelin).