Clinical Outcomes of Metabolic Surgery: Efficacy of Glycemic Control, Weight Loss, and Remission of Diabetes

Abstract

Since the 2007 Diabetes Surgery Summit in Rome, Italy, and the subsequent publishing of the world’s first guidelines for the surgical treatment of type 2 diabetes (T2D), much new evidence regarding the efficacy and safety of metabolic surgery has emerged. Additional observational cohort studies support the superior effects of surgery over medical treatment with respect to glycemic control, weight loss, and even reduction in mortality and microvascular complications associated with T2D. Furthermore, new safety data suggest that the perioperative morbidity and mortality of metabolic surgery (5% and 0.3%, respectively) are now similar to that of common low-risk procedures, such as cholecystectomy and hysterectomy. The largest advance, however, has been the completion of 11 randomized controlled trials from around the globe that compare surgery with medical treatment of T2D. These studies with follow-up duration of 1–5 years involve nearly 800 patients without surgical mortality and with major complication rates of less than 5% and a reoperation rate of 8%. All but 1 of the 11 randomized controlled trials have shown the superiority of surgery over medical management at achieving remission or glycemic improvement. Surgery was also superior to medical treatment with respect to improving cardiovascular risk factors, such as weight loss and dyslipidemia, while reducing medication burden. This new efficacy and safety evidence should help guide physicians across the globe to the appropriate use of surgery as an effective treatment for patients suffering from T2D and obesity.

Bariatric surgery and obesity: influence on the incretins

“…1 Surgical weight loss, a treatment of choice for severely obese individuals, is accompanied by the resolution or improvement of type 2 diabetes. 2,3 The predictors of diabetes remission after bariatric surgery include shorter diabetes duration, the type of surgical procedure and the amount of weight loss post-surgery. [4][5][6] However, improvement in glucose control after RYGBP or VSG occurs rapidly, and may involve mechanisms independent of weight loss.…”

Changes in quality of life in patients undergoing bariatric surgery following 24-months: comparison between gastric bypass and tubular vertical gastrectomy

“…A los 24 meses, los pacientes sometidos a bypass gástrico mantienen mejores puntuaciones solo en una de las dimensiones del SF-36 frente a la gastrectomía vertical tubular, función física 87,66 (19,17) frente a 76,78 (27,74); p = 0,005.…”

“…En el momento actual se está realizando evaluación de todos los sujetos incluidos en protocolo, con el fin de aumentar la muestra y medir los resultados a largo plazo. Por último, sería conveniente ampliar la investigación con un grupo control en tratamiento de la OM sin CB como se ha realizado en otro estudio 27 . No obstante, del presente trabajo se concluye que la CB es un tratamiento eficaz para la pérdida de peso y comporta un aumento de la CVRS de los pacientes tras 24 meses de seguimiento.…”

Relationship between Various Food Uptakes and Body Mass Index (BMI) in Japanese Young and Old Men and Women

“…Roux limb of jejunum results in food bypasses of 95% of the stomach and duodenum and most of the jejunum. The recently introduced vertical-sleeve gastrectomy involves removal of approximately 70% of the stomach, with subsequent acceleration of gastric emptying [28,29].…”