Long-term outcomes of bariatric surgery in patients with diabetes

ABSTRACT

Introduction: Initially seen as a weight-loss operation, bariatric surgery is now recognized as a metabolic procedure with a critical role in the management of type 2 diabetes mellitus (T2DM). Early improvement in glucose metabolism is a remarkable effect of surgery; however, what deserves equal thought are implications for long-term diabetes control and relapse. Evidence suggests the metabolic effects of surgery fatigue and a proportion of patients will experience relapse of T2DM, with or without weight regain. Herein, we discuss the evidence examining the durability of these effects and approaches to improve long-term control.

Areas covered: PubMed, Embase, CENTRAL, and Medline were searched for trials looking at outcomes for patients with obesity and T2DM undergoing bariatric surgery between January 2000 andDecember 2019. Additional studies were found by searching publications from related journals and references.

Export opinion: Bariatric surgery is a safe and effective treatment for T2DM and obesity however the response to surgery, like any other treatment is variable. Some patients will experience a relapse of diabetes in the long term. Recent developments in pharmacotherapy present an opportunity to augment or sustain what can be achieved with surgery. Combinational treatment may dramatically change the way both diseases are managed.

KEYWORDS:

• Obesity
• type 2 diabetes mellitus
• bariatric surgery
• weight-loss pharmacotherapy
• multi-modal care

Article highlights

• There is mounting level 1 evidence to support the notion that at present, bariatric surgery is the most effective treatment for T2DM in patients with obesity, irrespective of the procedure performed.

• There is significant variability in reported remission rates between studies but this is highly dependent on the definition used as well as the length of follow-up.

• A significant proportion of patients who initially experience remission will relapse however it is important to be mindful that glycaemic control remains improved from preoperative baseline levels with a concomitant reduction in cardiovascular risk factors.

• Achieving long-term control of T2DM must remain the primary goal of treatment however new strategies are needed to help maintain the metabolic effects of surgery, namely the adoption of multimodal care.

• For the first time, we have safe and effective pharmacotherapy which when utilized in combination with surgery may change the way we treat obesity and T2DM, sustaining the effects of a highly effective operation to provide long-term management options for a chronic and progressive disease.

Declaration of interest

A Sudlow has received a fellowship grant from the Royal College of Surgeons of England. C Le Roux has received grants from Science Foundation Ireland, Health Research Board, AnaBio, NovoNordisk, GI Dynamics, and has received personal fees from Eli Lilly, grants and personal fees from Johnson and Johnson. C Le Roux has also received personal fees from Sanofi Aventis, Astra Zeneca, Janssen, Bristol-Myers Squibb, Boehringer-Ingelheim, and has shares in Keyron. D Pournaras has received honoraria from NovoNordisk and Johnson and Johnson for lectures. 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.