Surgical treatment of type 2 diabetes: the surgeon perspective

Abstract

Type 2 diabetes mellitus (T2DM) is a major health priority globally, having achieved pandemic status in the twenty-first century. Several gastrointestinal procedures that were primarily designed to treat morbid obesity result in dramatic remission of diabetes. Studies in experimental rodent models and humans have shown that the glycemic benefits of surgery are at least in part weight-independent and extend to non-morbidly obese subjects with T2DM. Bariatric procedures differ in their ability to ameliorate type 2 diabetes, with intestinal bypass procedures being more effective than purely restrictive procedures. Several studies have demonstrated that the benefits of bariatric surgery extend beyond amelioration of hyperglycemia and include improvement in other cardiovascular risk factors such as dyslipidemia and hypertension. The safety and cost-effectiveness of bariatric surgery are also well established by several studies. In this paper, the authors present the surgeon perspective on the management of type 2 diabetes focusing on the efficacy, safety and cost-effectiveness of metabolic surgery. The available evidence warrants the inclusion of metabolic surgery in the treatment algorithm of type 2 diabetes.

Efficacy and safety of the adjustable gastric band – pooled interim analysis of the APEX and HERO studies at 48 weeks

“…This finding does not support data from previous studies, which reported that LAGB should be favored for lower BMI patients, and was less effective in patients with higher BMI 36 .…”

Effect of Early Weight Loss on Type 2 Diabetes Mellitus after 2 Years of Gastric Banding

“…Patients enrolled in the APEX trial were required to participate in the following visit schedule: visit 1 (screening); visit 2 (day 0, surgical procedure); visit 3 (week 2 ± 2 days); visits 4 to 13 (weeks 4,8,12,16,20,24,30,36,42, and 48 ± 5 days); visits 14 to 20 (semi-annual visits, months 18-54 ± 14 days); and visit 21 (final visit, month 60 ± 14 days).…”

“…2 The majority of obese patients are typically unable to achieve meaningful, sustainable weight loss through lifestyle changes and increased physical activity. 15,16 Consequently, surgical approaches, including restrictive bariatric surgery, could be considered as early treatment options for patients with T2DM, as significant weight loss early in the disease progression improves β-cell function and reduces insulin resistance. 17 Although many studies report improvement or remission of T2DM in patients after bariatric surgery, most studies are retrospective or uncontrolled observational case reviews, and as such, are of limited value.…”

Comment on: Visceral fat area as a new predictor of short-term diabetes remission after Roux-en-Y gastric bypass surgery in Chinese patients with a body mass index less than 35 kg/m2

“…Metabolic surgery is not a synonym for interventions in type 2 diabetes mellitus (T2DM) patients with a low body mass index (BMI), because the purpose of these procedures is to treat T2DM per se, rather than only to reduce weight [2]. Thus, it seems adequate to employ metabolic surgery in patients with mild obesity or even overweight with uncontrolled T2DM after rigorous medical and lifestyle interventions [3].…”