Pros and cons of Roux en-Y gastric bypass surgery in obese patients with type 2 diabetes

ABSTRACT

Introduction: The worldwide prevalence of obesity and type 2 diabetes (T2D) constitutes an epidemic that is a threat to public health. Bariatric surgery, including Roux en-Y gastric bypass (RYGB), is currently the most effective treatment to induce long-term weight loss and remission of co-morbid conditions. Surgery, however, comes with an added risk of complications, highlighting the need to understand the comparative effectiveness and risks of surgical versus conventional approaches to the treatment of obesity and T2D.

Areas covered: Positive and negative outcomes of RYGB surgery in patients with T2D are assessed, with a primary focus on RYGB surgery versus standard non-surgical treatment of obese patients with T2D in randomized clinical trials or high-quality observational cohorts.

Searches were conducted in the PubMed database up to 11 April 2019 for relevant studies.

Expert opinion: High-level evidence reveals that RYGB ameliorates the clinical manifestations of T2D to a significantly higher degree than medical therapy. Postoperative incidence of beneficial effects and complications, however, differ across subgroups of patients with different preoperative characteristics. Key knowledge gaps, particularly on long-term complications, microvascular- and macrovascular events, and mortality should be addressed, so treatment with RYGB can be applied in an individualized approach to maximize benefits and minimize complications.

KEYWORDS:

• Gastric bypass
• type 2 diabetes
• obesity
• diabetes remission
• complications
• bariatric surgery
• microvascular outcomes
• macrovascular outcomes
• dyslipidemia
• hypertension

Article highlights

• In randomized trials, RYGB is superior to non-surgical treatment options in terms of remission of T2D and lowering cardiovascular risk factors in patients with T2D.

• In long-term observational reports, RYGB seems to be associated with a lower incidence of micro- and macrovascular events and all-cause mortality.

• Cons of RYGB include perioperative- and long-term surgical complications, micronutrient deficiencies and postprandial symptomatic disorders (postprandial reactive hypoglycemia and dumping syndrome).

• An understanding of baseline determinants for both beneficial outcomes and complications following RYGB can help ensure optimal clinical indications of surgical, medical and lifestyle-interventions alone, or a mixture of all three strategies, when treating obese patients with T2D.

Declaration of interest

T Justinussesn, S Madsbad, K N Bojsen-Møller, and J Holst are affiliated with the Novo Nordisk Foundation Center for Basic Metabolic Research funded by the Novo Nordisk Foundation. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.