Published online Oct 15, 2021. doi: 10.4239/wjd.v12.i10.1587
Peer-review started: June 23, 2021
First decision: July 15, 2021
Revised: July 18, 2021
Accepted: August 25, 2021
Article in press: August 25, 2021
Published online: October 15, 2021
Processing time: 112 Days and 1.6 Hours
Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.
Core Tip: The ambit of metabolic surgery for diabetes has increased. Individuals with inadequate glycemic control can be considered for surgery if less severely obese, and even more so if they are of Asian origin. However, both diabetes and obesity are associated with multiple comorbidities that require optimization before surgery. There are several clinical guidelines for the preoperative management of individuals with obesity; however, specific suggestions addressing these concerns in persons with diabetes have not been recommended. It is important to achieve optimal glycemic control and diagnose and manage cardiovascular, pulmonary, gastrointestinal, and renal complications before surgery. Nutritional assessment, psychological evaluation, and ruling out specific endocrine disorders are other essential adjuncts. These guidelines will help to standardize the management of preoperative comorbidities and improve postoperative outcomes in individuals with diabetes who opt for metabolic surgery.