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A Review of the Current Evidence: Impact of Metabolic Surgery on Diabetes Outcomes and Obesity-Associated Macrovascular Complications

  • Macrovascular Complications in Diabetes (VR Aroda and L-S Chang, Section Editors)
  • Published:
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Abstract

Purpose of Review

Type 2 diabetes (T2D) and obesity are comorbidities that generally progress with time even when non-invasive therapies are prescribed. Indeed, weight loss that is achieved with behavioral modification alone is generally inconsistent and often short-lived. In contrast, although patients do experience weight regain with metabolic surgery, they still benefit from a significant net decrease in weight. As a result, T2D remission can be achieved in up to 60% of patients within 2 years after surgery. However, it is unknown if the positive effects of metabolic surgery extend to macrovascular disease risk reduction.

Recent Findings

As noted in four randomized controlled trials (RCTs), Roux-en-Y gastric bypass (RYGB) facilitates partial remission of T2D in about 30% of volunteers 5 years after surgery. Of the four RCTs, only one investigated the effects of sleeve gastrectomy (SG) at 5 years; that study found that the rate of partial relapse was slightly lower with SG (23%). However, observational studies indicate that the gap between RYGB and SG may be larger than that observed in RCTs. In contrast, the rate of full remission is noted infrequently 5 years after SG or RYGB. Metabolic surgery also mitigates macrovascular disease risk as indicated by multiple observational studies.

Summary

The effects of metabolic surgery on cardiometabolic parameters are clinically meaningful. The weight loss that is facilitated by metabolic surgery reduces the metabolic and inflammatory stress caused by T2D and obesity. In turn, metabolic surgery likely mitigates macrovascular disease risk. Additional evidence from RCTs is needed to substantiate the effects of metabolic surgery on macrovascular disease risk.

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Authors and Affiliations

  1. Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Karim G. Kheniser

  2. Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Ali Aminian

  3. Department of Endocrinology and Metabolism, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Sangeeta R. Kashyap

  4. Cleveland, USA

    Sangeeta R. Kashyap

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Kheniser, K.G., Aminian, A. & Kashyap, S.R. A Review of the Current Evidence: Impact of Metabolic Surgery on Diabetes Outcomes and Obesity-Associated Macrovascular Complications. Curr Diab Rep 20, 57 (2020). https://doi.org/10.1007/s11892-020-01350-8

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