Bariatric surgery for diabetes management

Abstract

To review the role of bariatric surgery in the treatment of patients with type 2 diabetes. Multiple studies demonstrate that bariatric surgical approaches to obesity lead to substantial and sustained weight loss. Patients with diabetes have remission of hyperglycemia or require reduced medications. Surgical intervention for patients with more recent diabetes onset may have higher rates of resolution than patients with longer duration disease. In addition, dyslipidemia and hypertension improve. A short-term randomized clinical trial comparing laparoscopic banding with optimal medical management suggests surgery leads to more improvement in multiple metabolic measures. Perioperative risk is low and observational studies suggest long-term survival is favorable for obese patients following bariatric surgery. Metabolic risks of bariatric procedures are reviewed. Although there are several surgical approaches for weight management, improvements in diabetes, including achievement of near normal glycemia without medication or reduced medications, are realized in many patients. Early surgical intervention for overweight type 2 diabetes may be clinically appropriate in patients for in whom operative risks are acceptable.