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The Growing Role of Bariatric Surgery in the Management of Type 2 Diabetes: Evidences and Open Questions

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Abstract

The use of bariatric surgery in the clinical management of type 2 diabetes has been recently endorsed in the clinical practice recommendations released by the most influential diabetologic associations. However, authoritative critic voices about the application of metabolic surgery in type 2 diabetes continue to appear in diabetologic literature. In this review, we will try therefore to understand what the reasons for this apparent dichotomy. In this paper, we revised what we believe are now clear evidences about the role of bariatric surgery in the treatment of type 2 diabetes in patients with morbid obesity: the efficacy of bariatric surgery in metabolic control, the existence of plausible weight-independent metabolic mechanisms at least in some bariatric procedure, and the importance of the early referral to surgery in patients with firm indications. However, we stressed also the lack of clear high-quality long-term data about the effects of bariatric surgery in the prevention of both macro- and micro-vascular hard endpoints in patients with type 2 diabetes. The accrual of these results will be critical to completely clarify the risk/benefit ratio of bariatric surgery in diabetes, as compared to current pharmacologic therapies. This may be particularly important in patients in which data on long-term efficacy are still not completed, such as in patients with lower BMI levels.

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Authors and Affiliations

  1. Unità Bariatrica, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Padova, Padova, Italy

    Luca Busetto

  2. Dipartimento di Medicina Interna, Università di Roma “Tor Vergata”, Rome, Italy

    Paolo Sbraccia

  3. Unità di Endocrinologia, Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Ospedale “Garibaldi”, Catania, Italy

    Lucia Frittitta

  4. Dipartimento di Medicina, Chirurgia e Odontoiatria, Università degli Studi di Milano, Ospedale San Paolo, Milan, Italy

    Antonio E. Pontiroli

  5. Clinica Medica I, Policlinico Universitario, Via Giustiniani 2, 35128, Padova, Italy

    Luca Busetto

Authors
  1. Luca Busetto
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  2. Paolo Sbraccia
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  3. Lucia Frittitta
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  4. Antonio E. Pontiroli
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Correspondence to Luca Busetto.

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Busetto, L., Sbraccia, P., Frittitta, L. et al. The Growing Role of Bariatric Surgery in the Management of Type 2 Diabetes: Evidences and Open Questions. OBES SURG 21, 1451–1457 (2011). https://doi.org/10.1007/s11695-011-0471-5

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