Bariatric Surgery in the Treatment of Type 2 Diabetes

• Published in: Current diabetes reports Vol. 19; no. 12; pp. 156 - 10
• Main Authors: Affinati, Alison H., Esfandiari, Nazanene H., Oral, Elif A., Kraftson, Andrew T.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2019; Springer Nature B.V
• Subjects: Bariatric Surgery - methods; Diabetes; Diabetes Mellitus, Type 2 - etiology; Diabetes Mellitus, Type 2 - physiopathology; Diabetes Mellitus, Type 2 - surgery; Gastrointestinal surgery; Humans; Medicine; Medicine & Public Health; Obesity; Obesity - complications; Obesity - physiopathology; Obesity - surgery; Remission (Medicine); Section Editor; Therapies and New Technologies in the Treatment of Diabetes (M Pietropaolo; Topical Collection on Therapies and New Technologies in the Treatment of Diabetes; Obesity; Diabetes remission; Metabolic surgery; Diabetes mellitus; Bariatric surgery
• ISSN: 1534-4827; 1539-0829; 1539-0829
• DOI: 10.1007/s11892-019-1269-4

Purpose of Review We seek to characterize the impact of bariatric surgery on diabetes mellitus by recalling its history, examining the clinical data, exploring the putative mechanisms of action, and anticipating its future. Recent Findings Results of clinical trials reveal that bariatric surgery induces remission of diabetes in 33–90% of individuals at 1-year post-treatment versus 0–39% of medically managed. Remission rates decrease over time but remain higher in surgically treated individuals. Investigations have revealed numerous actions of surgery including effects on intestinal physiology, neuronal signaling, incretin hormone secretion, bile acid metabolism, and microbiome changes. Summary Bariatric surgery improves control of diabetes through both weight-dependent and weight-independent actions. These various mechanisms help explain the difference between individuals treated surgically vs. medically. They also explain differing effects of various bariatric surgery procedure types. Understanding how surgery affects diabetes will help optimize utilization of the therapy for both disease prevention and treatment.