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Science, clinical outcomes and the popularization of diabetes surgery

Lebovitz, Harold E.

Current Opinion in Endocrinology & Diabetes and Obesity: October 2012 - Volume 19 - Issue 5 - p 359–366
doi: 10.1097/MED.0b013e328358301f
OBESITY AND NUTRITION: Edited by Caroline M. Apovian and Jeffrey I. Mechanick
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Purpose of review Bariatric surgery is an important option for the treatment of severe (type III) obesity. Its role in the management of type 2 diabetes in overweight and obese patients needs to be defined.

Recent findings Intensified medical therapy can achieve target metabolic goals in many but not all patients with type 2 diabetes. Bariatric surgery can normalize or improve glycemia in severely obese patients with type 2 diabetes. The complications of bariatric surgery are significant and include operative mortality, early and late surgical complications and late nutritional deficiencies. Comparative studies of bariatric surgery versus intensive medical therapy in the management and clinical outcomes of patients with type 2 diabetes are needed to evaluate relative risk/benefit of each. Bariatric surgery studies in type 2 diabetes are lacking long-term follow-up metabolic and clinical outcomes data.

Summary Current data are insufficient to recommend bariatric surgery as a primary treatment for type 2 diabetes. However, it can be recommended for patients whose target metabolic control cannot be achieved by intensive glycemic control because of intolerance or inadequate responses to nutritional and pharmacologic treatments.

State University of New York Health Science Center at Brooklyn, Brooklyn, New York, USA

Correspondence to Harold E. Lebovitz, SUNY Health Science Center-Brooklyn, 450 Clarkson Avenue, Brooklyn, NY 11203, USA. Tel: +1 718 720 1618; e-mail: hlebovitz1@hotmail.com

© 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins