The Role of Bariatric Surgery in Obese Patients with Diabetes
Primary or Rescue Therapy?
Praveena Gandikota
Endocrine Fellow, Endocrine, Diabetes and Nutrition Division, Department of Medicine, St Luke's Roosevelt Hospital, New York, NY, USA
Search for more papers by this authorBlandine Laferrère
Assistant Professor of Medicine, Division of Endocrinology, Diabetes and Nutrition Obesity Research Center Department of Medicine, St Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
Search for more papers by this authorPraveena Gandikota
Endocrine Fellow, Endocrine, Diabetes and Nutrition Division, Department of Medicine, St Luke's Roosevelt Hospital, New York, NY, USA
Search for more papers by this authorBlandine Laferrère
Assistant Professor of Medicine, Division of Endocrinology, Diabetes and Nutrition Obesity Research Center Department of Medicine, St Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
Search for more papers by this authorAdrian Vella MD FRCP(Edin.)
Division of Diabetes, Endocrinology & Metabolism, Earl and Annette R. McDonough Professor, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorSummary
Obesity and type 2 diabetes mellitus (T2DM) are major public health issues that are closely related. Lifestyle modifications (LSM) with diet and exercise leading to weight loss are cornerstones of T2DM management along with pharmacologic therapy. Bariatric surgery is increasingly becoming popular for management of morbid obesity and its related comorbidities including T2DM. Weight loss is a key factor in the improvement of T2DM after bariatric surgery. Nearly 30% of patients who undergo bariatric surgery have T2DM, although about a third of these patients are undiagnosed. The percentage of diabetes remission varies according to surgery: 95% after biliopancreatic diversion (BPD)/duodenal switch, 80% after Roux-en-Y gastric bypass (RYGBP), 80% with gastroplasty and 57-73% after gastric banding. Cause-specific mortality in the RYGBP surgery group decreased by 92% for diabetes. Hyperinsulinemic hypoglycemia associated is a relatively uncommon complication of RYGB and has variable severity.
References
- Still CD , Wood GC , Benotti P et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study . Lancet 2 ( 1 ): 38 – 45 , 2014 .
- Nguyen KT , Billington CJ , Vella A et al. Preserved insulin secretory capacity and weight loss are the predominant predictors of glycemic control in patients with type 2 diabetes randomized to Roux-en-Y gastric bypass . Diabetes 64 ( 9 ): 3104 – 3110 , 2015 .
- Dirksen C , Bojsen-Møller KN , Jørgensen NB et al. Exaggerated release and preserved insulinotropic action of glucagon-like peptide-1 underlie insulin hypersecretion in glucose-tolerant individuals after Roux-en-Y gastric bypass . Diabetologia 56 ( 12 ): 2679 – 2687 , 2013 .
- Pi-Sunyer X , Blackburn G , Brancati FL et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial . Diabetes Care . 30 ( 6 ): 1374 – 1383 , 2007 .
- Wadden TA , Sternberg JA , Letizia KA et al. Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective . Int J Obes . 13 ( Suppl 2 ): 39 – 46 , 1989 .
- Pories WJ , Swanson MS , MacDonald KG et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus . Ann Surg . 222 ( 3 ): 339 – 350 , 1995 .
- Sjostrom L , Lindroos AK , Peltonen M et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery . N Engl J Med . 351 ( 26 ): 2683 – 2693 , 2004 .
- Laferrère B , Heshka S , Wang K et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes . Diabetes Care . 30 ( 7 ): 1709 – 1716 , 2007 .
- Morinigo R , Moize V , Musri M et al. Glucagon-like peptidel, peptide YY, hunger, and satiety after gastric bypass surgery in morbidly obese subjects . J Clin Endocrinol Metab . 91 ( 5 ): 1735 – 1740 , 2006 .
- Laferrère B , Teixeira J , McGinty J et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes . J Clin Endocrinol Metab . 93 ( 7 ): 2479 – 2485 , 2008 .
- Bose M , Machineni S , Olivan B et al. Superior appetite hormone profile after equivalent weight loss by gastric bypass compared to gastric banding . Obesity (Silver Spring) . 18 ( 6 ): 1085 – 1091 , 2010 .
- le Roux CW , Welbourn R , Werling M et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass . Ann Surg . 246 ( 5 ): 780 – 785 , 2007 .
- Naslund E , Gryback P , Hellstrom PM et al. Gastrointestinal hormones and gastric emptying 20 years after jejunoileal bypass for massive obesity . Int J Obes Relat Metab Disord . 21 ( 5 ): 387 – 392 , 1997 .
- Vidal J , Ibarzabal A , Nicolau J et al. Short-term effects of sleeve gastrectomy on type 2 diabetes mellitus in severely obese subjects . Obes Surg . 17 ( 8 ): 1069 – 1074 , 2007 .
- Strader AD , Vahl TP , Jandacek RJ et al. Weight loss through ileal transposition is accompanied by increased ileal hormone secretion and synthesis in rats . Am J Physiol Endocrinol Metab . 288 ( 2 ): E447 – E453 , 2005 .
- Rubino F , Forgione A , Cummings DE et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes . Ann Surg . 244 ( 5 ): 741 – 749 , 2006 .
- Olivan B , Teixeira J , Bose M et al. Effect of weight loss by diet or gastric bypass surgery on peptide YY3-36 levels . Ann Surg . 249 ( 6 ): 948 – 953 , 2009 .
- Patti ME , Houten SM , Bianco AC et al. Serum bile acids are higher in humans with prior gastric bypass: potential contribution to improved glucose and lipid metabolism . Obesity (Silver Spring) . 17 ( 9 ): 1671 – 1677 , 2009 .
- Zhang H , DiBaise J , Zuccolo A et al. Human gut microbiota in obesity and after gastric bypass . PNAS . 106 ( 7 ): 2364 – 2370 , 2009 .
- American Diabetes Association . Diabetes Care . 33 ( Suppl 1 ): S1 – S2 , 2010 .
- Cheung BM , Ong KL , Cherny SS et al. Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006 . Am J Med . 122 ( 5 ): 443 – 453 , 2009 .
- Holman RR , Farmer AJ , Davies MJ et al. Three-year efficacy of complex insulin regimens in type 2 diabetes . NEngl J Med . 361 ( 18 ): 1736 – 1747 , 2009 .
- Residori L , Garcia-Lorda P , Flancbaum L et al. Prevalence of co-morbidities in obese patients before bariatric surgery: effect of race . Obes Surg . 13 ( 3 ): 333 – 340 , 2003 .
- Buchwald H , Avidor Y , Braunwald E et al. Bariatric surgery: a systematic review and meta-analysis . JAMA . 292 ( 14 ): 1724 – 1737 , 2004 .
- Dixon JB , O'Brien PE , Playfair J et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial . JAMA . 299 ( 3 ): 316 – 323 , 2008 .
- Sjostrom L , Narbro K , Sjostrom CD et al. Effects of bariatric surgery on mortality in Swedish obese subjects . NEngl J Med . 357 ( 8 ): 741 – 752 , 2007 .
- Vetter ML , Cardillo S , Rickels MR , and Iqbal N . Narrative review: effect of bariatric surgery on type 2 diabetes mellitus . Ann Intern Med . 150 ( 2 ): 94 – 103 , 2009 .
- Schauer PR , Burguera B , Ikramuddin S et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus . Ann Surg . 238 ( 4 ): 467 – 784 , 2003 .
- Sugerman HJ , Wolfe LG , Sica DA , and Clore JN . Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss . Ann Surg . 237 ( 6 ): 751 – 756 , 2003 .
- Buse JB , Caprio S , Cefalu WT et al. How do we define cure of diabetes? Diabetes Care . 32 ( 11 ): 2133 – 2135 , 2009 .
- Purnell JQ and Flum DR . Bariatric surgery and diabetes: who should be offered the option of remission? JAMA . 301 ( 15 ): 1593 – 1595 , 2009 .
- Shah M , Simha V , and Garg A . Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status . J Clin Endocrinol Metab . 91 ( 11 ): 4223 – 4231 , 2006 .
- Schauer PR , Kashyap SR , Wolski K et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes . N Engl J Med 366 ( 17 ): 1567 – 1576 , 2012 .
- Schauer PR , Bhatt BL , Kirwan JP et al. Bariatric surgery versus intensive medical therapy for diabetes – 3-year outcomes . N Engl J Med 370 ( 21 ): 2002 – 2013 , 2014 .
- Adams TD , Gress RE , Smith SC et al. Long-term mortality after gastric bypass surgery . N Engl J Med . 357 ( 8 ): 753 – 761 , 2007 .
- Salehi , M , Vella A , McLaughlin T et al. Hypoglycemia after gastric bypass surgery: current concepts and controversies . J Clin Endocrinol Metab 103 ( 8 ): 2815 – 2826 , 2018 .
- Depaula AL , Macedo AL , Mota BR , and Schraibman V . Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21-29 . Surg Endosc . 23 ( 6 ): 1313 – 1320 , 2009 .
- Chiellini C , Rubino F , Castagneto M et al. The effect of bilio-pancreatic diversion on type 2 diabetes in patients with BMI <35 kg/m 2 . Diabetologia . 52 ( 6 ): 1027 – 1030 , 2009 .
- Shah SS , Todkar JS , Shah PS , and Cummings DE . Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index < 35 kg/m 2 . Surg Obes Relat Dis . 6 ( 4 ): 332 – 338 , 2010 .
- Ikramuddin S , Korner J , Lee W-J et al. Durability of addition of Roux-en-Y gastric bypass to lifestyle intervention and medical management in achieving primary treatment goals for uncontrolled type 2 diabetes in mild-to-moderate obesity: a randomized control trial . Diabetes Care 39 ( 9 ): 1510 – 1518 , 2016 .
- Aguirre V , Stylopoulos N , Grinbaum R , and Kaplan LM . An endoluminal sleeve induces substantial weight loss and normalizes glucose homeostasis in rats with diet-induced obesity . Obesity (Silver Spring) . 16 ( 12 ): 2585 – 2592 , 2008 .
- Egan AM and Vella A . Endoscopic treatments for obesity: the good, the bad, and the ugly . Endocrinol Metab Clin North Am 49 ( 2 ): 315 – 328 , 2020 .
- van Baar ACG et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective, multicentre study . Gut 69 ( 2 ): 295 – 303 , 2020 .