Bariatric surgery and diabetes remission: how far have we progressed?

Abstract

Obesity and type 2 diabetes mellitus have been associated with higher morbidity and mortality. Bariatric surgery results in substantial and sustained weight loss in morbidly obese patients and improves obstructive sleep apnea. Furthermore, bariatric surgery improves diabetes control, hypertension, quality of life, stroke, myocardial infarction and reduces mortality. Interestingly, bariatric surgery induces high rates of short and long-term diabetes remission. While the exact mechanisms behind this are not completely understood, improved insulin action, β-cell function and a complex interplay of hormones in the entero-insular axis appear to play major roles. Insulin action improves proportionally to weight loss and it gets completely normalized especially after bilio-pancreatic diversion. β-Cell function also seems to improve after a variety of bariatric surgeries. Seemingly, baseline β-cell function is able to predict future diabetes remission. This article will review the effectiveness of bariatric procedures on the remission and improvement of diabetes and its implicated mechanisms.

Keywords:

• bariatric surgery
• diabetes remission
• ghrelin
• incretin
• Type 2 diabetes

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 can be an effective tool for remission in Type 2 diabetes in select population

• It should not be used as a last resort, may be considered early on, especially in obese subjects.

• Intestinal manipulation leading to increase in insulinotropic hormones plays a key role

• Higher pre-operative BMI, lesser duration of diabetes, absence of vascular complications and minimal usage of insulin are some parameters associated with higher chances of remission of diabetes following bariatric surgery.