The role of bariatric surgery to treat diabetes: current challenges and perspectives

Abstract

Bariatric surgery is emerging as a powerful weapon against severe obesity and type 2 diabetes mellitus (T2DM). Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to treat T2DM, especially in light of accumulating evidence that surgery with gastrointestinal manipulations may result in T2DM remission (metabolic surgery). The major mechanisms mediating the weight loss-independent effects of bariatric surgery comprise effects on tissue-specific insulin sensitivity, β-cell function and incretin responses, changes in bile acid composition and flow, modifications of gut microbiota, intestinal glucose metabolism and increased brown adipose tissue metabolic activity. Shorter T2DM duration, better preoperative glycemic control and profound weight loss, have been associated with higher rates of T2DM remission and lower risk of relapse. In the short and medium term, a significant amount of weight is lost, T2DM may completely regress, and cardiometabolic risk factors are dramatically improved. In the long term, metabolic surgery may achieve durable weight loss, prevent T2DM and cancer, improve overall glycemic control while leading to significant rates of T2DM remission, and reduce total and cause-specific mortality. The gradient of efficacy for weight loss and T2DM remission comparing the four established surgical procedures is biliopancreatic diversion >Roux-en-Y gastric bypass >sleeve gastrectomy >laparoscopic adjustable gastric banding. According to recently released guidelines, bariatric surgery should be recommended in diabetic patients with class III obesity, regardless of their level of glycemic control, and patients with class II obesity with inadequately controlled T2DM despite lifestyle and optimal medical therapy. Surgery should also be considered in patients with class I obesity and inadequately controlled hyperglycemia despite optimal medical treatment.

Periodontal complications with obesity

“…110 However, the development of (laparoscopic) bariatric surgery has shown the greatest impact on weight loss, weight-loss maintenance, and improvement in complications caused by obesity, as well as opening research areas on mechanisms for weight loss, including gut hormones, microbiota, and bile acids. [111][112][113] It is also increasingly recognized that the weight loss achieved, and perhaps the mechanisms involved after bariatric surgery, have marked beneficial effects on adipose tissue and systemic inflammation. 114 in determining the validity and clinical applicability of the findings to their patients or setting.…”

Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?

“…Restrictive bariatric procedures, such as laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG), are technically simple, have a low surgical risk [1,2] and are effective in achieving weight loss and managing obesity-related comorbidities, e.g., hypertension (HTN), type 2 diabetes (T2DM) and hyperlipidemia [3,4]. Despite these benefits, surgical revision is performed in 20-60% of LABG patients due to insufficient weight loss or surgical complications and in 5.7% of LSG patients due to weight regain and a relapse of comorbidities [5,6].…”

Molecular Basis of Blood Glucose Regulation

“…When medicines and lifestyle changes are not enough to manage diabetes, a less common treatment can become an option. Other treatments include different surgical procedures for treating type-I or type-II diabetes [21][22][23][24][25] which are as follows:…”

“…Moreover it can also be monitored by the time occurrence of diabetes and on duration of usage of insulin. Current research suggested that weight-loss surgery also may help to improve blood glucose control in obese type-I diabetic people but still scientists are finding long-term results of this in type-I and II diabetic patients [21].…”