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An update on the role of bariatric surgery in diabetes management

Malkani, Samir

Current Opinion in Endocrinology & Diabetes and Obesity: April 2015 - Volume 22 - Issue 2 - p 98–105
doi: 10.1097/MED.0000000000000143
DIABETES AND THE ENDOCRINE PANCREAS I: Edited by David M. Harlan
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Purpose of review To review the current state of knowledge on the effects of weight loss (bariatric) surgical procedures in individuals with type 2 diabetes.

Recent findings Observational and randomized studies provide robust data on the efficacy of bariatric surgery for weight loss and improvement in hyperglycemia. Follow-up information up to 20 years is now available. Surgery offers similar benefits in individuals with BMI 30–35, compared with those with higher BMI. There is a better understanding of the role of gut hormones and nonhormonal factors on weight loss and glucose metabolism. Preoperative factors that predict favorable surgical outcomes have been identified.

Summary Of commonly performed procedures, adjustable gastric banding has the lowest efficacy for weight loss and diabetes remission and a higher complication rate. Roux-en-Y gastric bypass and sleeve gastrectomy are comparable in terms of efficacy and complications. Remission rates for diabetes range between 40 and 80%; randomized trials show slightly lower remission rates compared with observational studies. At 20 years, approximately 50% of remitters have relapse of diabetes. Complex gut hormonal changes, caloric restriction, and other intestinal factors form the basis for metabolic effects of surgery. Better preoperative β-cell function is the strongest predictor for remission. Long-term follow-up data is still sparse.

Diabetes Center of Excellence, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Correspondence to Samir Malkani, University of Massachusetts Medical School, AC4-127, 55 Lake Avenue North, Worcester, MA 01655, USA. Tel: +1 508 856 3800; e-mail: samir.malkani@umassmemorial.org

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