Bariatric Surgery for Patients with Diabetes Mellitus

Abstract

Obesity is associated with increased morbidity and mortality. Morbidity appears with hypertension, lipid disturbances, non-alcoholic steatohepatitis, obstructive sleep apnea, polycystic ovary syndrome, insulin resistance and diabetes. These comorbidities are responsible for more than 2.5 millions deaths per year worldwide with mortality rate twelve times than that in young normal weight men. Obesity and DM are increasing in incidence. Having one treatment that can alleviate both diseases is ideal. Although these diseases have traditionally been thought of as medical, there is validity in altering the treatment paradigm to include surgical treatment. The exact nature of the diabetic remission through surgery is controversial. It is likely that a combination of a calorie-restricted diet, gastrointestinal hormonal changes, and weight loss result in an early and longlasting remission for DM (type 2). Bariatric surgery has opened new vistas, producing durable full remission of DM (type 2) with normalization of A1C levels over time and discontinuation of all antidiabetes medication for many patients. These advances create new opportunities for exploring the mechanisms of DM (type 2) and its control through pharmaceutical approaches. DM is no longer an irreversible, incurable, or hopeless disease. Bariatric surgical procedures are categorized into 2 main types; restrictive and malabsorptive. Some operations combine both restriction and malabsorption. The operations that are most frequently performed are the Roux-en-Y gastric bypass, biliopancreatic diversion, mini-gastric bypass, and sleeve gastrectomy. The Recent procedures in treatment of DM are single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) surgery and sleeve gastrectomy and transit bipartition. T2DM can be considered a gastrointestinal disease that can be surgically treated. Interventional diabetology may be a new modality for diabetes care in the future. Novel surgical procedures may help elucidate the underlying pathophysiology and mechanism of T2DM, thus producing a better future for individuals with this deadly disease.