Skip to main content
SpringerLink
Log in

Gastrointestinal weight loss surgery for the management of type 2 diabetes: A view from Greece

  • Review Article
  • Published:
Hellenic Journal of Surgery

Abstract

Several gastrointestinal operations of bariatric surgery, originally designed to achieve and maintain weight loss, can also induce long-term remission of type 2 diabetes mellitus as well as improve other metabolic conditions including hypertension and dyslipidaemia. Moreover, bariatric surgery is increasingly being explored for the treatment of diabetes in moderately obese and non-obese diabetic patients, with positive results. The differences observed amongst the types of bariatric surgery in better control (i.e. sleeve gastrectomy) versus full remission (i.e. Roux-en-Y gastric bypass) of diabetes postoperatively constitute a significant field of study. How surgical gastrointestinal interventions achieve these changes is of a great interest to research, and is evolving rapidly. Several studies have provided evidence that surgical procedures bypassing parts of the small intestine improve glucose homeostasis through mechanisms beyond reduced food intake and body weight. The two major hypotheses put forth to explain these mechanisms are the ‘foregut’ and the ‘hindgut’ hypothesis, focusing on the changes of the secretion pattern of gastrointestinal hormones and neuroendocrine signals observed after surgical manipulation of the gastrointestinal tract. Research to elucidate such weight-independent anti-diabetes mechanisms should facilitate the design of novel anti-diabetic gastrointestinal manipulations, devices and pharmacotherapeutics for obese and non-obese diabetic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Whiting DR, Guariguata L, Weil C, et al. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011; 94: 311–21

    Article  PubMed  Google Scholar 

  2. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683–93

    Article  PubMed  Google Scholar 

  3. Friedman MN, Sancetta AJ, Magovern GJ. The amelioration of diabetes mellitus following subtotal gastrectomy. Surg Gynecol Obstet 1955; 100: 201–4

    CAS  PubMed  Google Scholar 

  4. Pories WJ, Swanson MS, Mac Donald KG, et al. Who would have thought it? An operation proves to be the most eff ective therapy for adult-onset diabetes mellitus. Ann Surg 1995; 222: 339–52

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg 2003; 238: 467–84

    PubMed  PubMed Central  Google Scholar 

  6. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009; 122: 248–56

    Article  PubMed  Google Scholar 

  7. Brethauer SA, Aminian A, Romero-Talamas H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes. Ann Surg 2013; 258: 628–36

    PubMed  PubMed Central  Google Scholar 

  8. Sjostrom L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA 2014; 311: 2297–304

    Article  PubMed  Google Scholar 

  9. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes–3-year outcomes. N Engl J Med 2014; 370: 2002–13

    Article  PubMed  Google Scholar 

  10. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 2012; 366: 1577–85

    Article  CAS  PubMed  Google Scholar 

  11. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012; 366: 1567–76

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs. intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA 2013; 309: 2240–9

    CAS  PubMed  Google Scholar 

  13. Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 2007; 142: 621–32

    Article  PubMed  Google Scholar 

  14. NHMRC. Clinical practice guidelines for the management of overweight and obesity in adults. Canberra: National Health and Medical Research Council, 2003

  15. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007; 357: 753–61

    Article  CAS  PubMed  Google Scholar 

  16. Maggard-Gibbons M, Maglione M, Livhits M, et al. Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review. JAMA 2013; 309: 2250–61

    Article  CAS  PubMed  Google Scholar 

  17. Cohen RV, Pinheiro JC, Schiavon CA, et al. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care 2012; 35: 1420–8

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus. Arch Surg 2011; 146: 143–8

    Article  PubMed  Google Scholar 

  19. Rubino F, Kaplan LM, Schauer PR, et al. The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg 2010; 251: 399–405

    Article  PubMed  Google Scholar 

  20. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care 2009; 32:S13–61

    Article  PubMed Central  Google Scholar 

  21. Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med 2011; 28: 628–42

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Dixon JB, Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet 2012; 379: 2300–11

    Article  PubMed  Google Scholar 

  23. Ardestani A, Rhoads D, Tavakkoli A. Insulin cessation and diabetes remission after bariatric surgery in adults with insulin-treated type 2 diabetes. Diabetes Care 2015; 38: 659–64

    CAS  PubMed  Google Scholar 

  24. Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: A new perspective for an old disease. Ann Surg 2004; 239: 1–11

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pacheco D, Luis DA, Romero A, et al. The effects of duodenal- jejunal exclusion on hormonal regulation of glucose metabolism in Goto-Kakizaki rats. Am J Surg 2007; 194: 221–4

    Article  CAS  PubMed  Google Scholar 

  26. Troy S, Soty M, Ribeiro L, et al. Intestinal gluconeogenesis is a key factor for early metabolic changes after gastric bypass but not after gastric lap-band in mice. Cell Metab 2008; 8: 201–11

    Article  CAS  PubMed  Google Scholar 

  27. Kamvissi V, Salerno A, Bornstein SR. Incretins or Anti- Incretins? A New Model for the “Entero-Pancreatic Axis”. Horm Metab Res 2015; 47: 84–7

    CAS  PubMed  Google Scholar 

  28. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg 2002; 236: 554–9

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinic of SOS Medicine, Athens Euroclinic, External Research Associate at the Hellenic Pasteur Institute, Athens, Greece

    Athina N. Kapralou

  2. University of Arizona School of Medicine, Honor Health Bariatric Center, Arizona, USA

    J. M. Swain

  3. Endocrinology and Metabolism, University of Athens Medical School, Diabetes Mellitus Unit, Athens Euroclinic, Athens, Greece

    E. Diamanti-Kandarakis

  4. University of Athens Medical School, Athens, Greece

    J. Bramis

Authors
  1. Athina N. Kapralou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. M. Swain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Diamanti-Kandarakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Bramis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Athina N. Kapralou.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kapralou, A.N., Swain, J.M., Diamanti-Kandarakis, E. et al. Gastrointestinal weight loss surgery for the management of type 2 diabetes: A view from Greece. Hellenic J Surg 88, 252–256 (2016). https://doi.org/10.1007/s13126-016-0327-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13126-016-0327-5

Keywords

Search

Navigation