Bariatric Surgery in the Treatment of Type 2 Diabetes
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.
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.
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.
KeywordsBariatric surgery Metabolic surgery Diabetes mellitus Diabetes remission Obesity
Alison H. Affinati reports a grant from NIDDK (F32 DK122660).
Compliance with Ethical Standards
Conflict of Interest
Alison H. Affinati, Nazanene H. Esfandiari, and Andrew T. Kraftson declare that they have no conflict of interest.
Elif A. Oral reports grants from Gi Dynamics; grants, personal fees, and non-financial support from Aegerion Pharmaceuticals; grants and personal fees from Akcea Therapeutics; grants from Ionis Pharmaceuticals; grants and personal fees from Regeneron Pharmaceuticals; and grants from Gemphire Therapeutics. In addition, Dr. Oral has a patent issue on an Intragastric device.
Human and Animal Rights and Informed Consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (include name of committee + reference number) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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