Bariatric surgery for the treatment of Type 2 diabetes: a step closer?

Abstract

Our objective in the present article is to comment on the recently published randomized control trials of bariatric surgery versus medical treatment for managing Type 2 diabetes. In particular, we will discuss how these trials impact the evidence base for the addition of bariatric surgery in Type 2 diabetes treatment algorithms.

Keywords::

• calorie restriction
• diabetes relapse
• diabetes remission
• obesity
• Roux-en-Y gastric bypass
• Type 2 diabetes
• vertical sleeve gastrectomy
• weight loss

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Bariatric surgery (BS) results in large and sustained weight loss and in Type 2 diabetes (DM2) remission, and has become an option in some DM2 treatment guidelines.

• BS is indicated for persons with a BMI ≥40 and/or ≥35 kg/m², with the presence of co-morbidities, such as diabetes, hypertension, dyslipidemia and coronary heart disease.

• To date, four randomized control trials (RCTs) have been published comparing the effect of BS with medical treatment in DM2.

• These studies demonstrated an improvement of DM2 after medical treatment, but greater improvement after BS, regardless of the surgical procedure.

• Study design, selection of patients for BS and definition of DM2 remission were quite different among the RCTs, making it difficult to compare outcomes.

• Even though the remission of DM2 after BS has been documented, limited data are available on its long-term recurrence.

• Follow-up studies of the current RCTs may be considered to document both the long-term safety, the duration of the positive effect of this treatment and the impact on cardiovascular complications.

• Such studies would provide an evidence base for the implementation of potential new guidelines for the treatment of DM2 and the prevention of its complications.