Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 25, 2015; 6(8): 990-998
Published online Jul 25, 2015. doi: 10.4239/wjd.v6.i8.990
Metabolic surgery: A paradigm shift in type 2 diabetes management
Joseph M Pappachan, Ananth K Viswanath
Joseph M Pappachan, Ananth K Viswanath, Department of Endocrinology and Diabetes, New Cross Hospital, the Royal Wolverhampton Hospital NHS Trust, Wolverhampton WV10 0QP, United Kingdom
Author contributions: Viswanath AK conceived the idea; Pappachan JM wrote the initial draft of the paper; both authors contributed to literature search and final preparation of the manuscript.
Conflict-of-interest statement: Ananth K Viswanath received lecture fees from MSD, NovoNordisk, Takeda, Eilly Lilly, Jansen and sponsorship from NovoNordisk, Takeda, Novartis and Jansen to attend international conferences. Joseph M Pappachan has no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Joseph M Pappachan, MD, MRCP (London), Department of Endocrinology and Diabetes, New Cross Hospital, the Royal Wolverhampton Hospital NHS Trust, Wolverhampton Road, Wolverhampton WV10 0QP, United Kingdom. drpappachan@yahoo.co.in
Telephone: +44-1922-721172 Fax: +44-1922-721172
Received: April 12, 2015
Peer-review started: April 15, 2015
First decision: April 27, 2015
Revised: April 30, 2015
Accepted: May 27, 2015
Article in press: May 28, 2015
Published online: July 25, 2015
Processing time: 113 Days and 17.8 Hours
Abstract

Obesity and type 2 diabetes mellitus (T2DM) are major public health issues globally over the past few decades. Despite dietary interventions, lifestyle modifications and the availability of several pharmaceutical agents, management of T2DM with obesity is a major challenge to clinicians. Metabolic surgery is emerging as a promising treatment option for the management of T2DM in the obese population in recent years. Several observational studies and a few randomised controlled trials have shown clear benefits of various bariatric procedures in obese individuals in terms of improvement or remission of T2DM and multiple other health benefits such as improvement of hypertension, obstructive sleep apnoea, osteoarthritis and non-alcoholic fatty liver disease. Uncertainties about the long-term implications of metabolic surgery such as relapse of T2DM after initial remission, nutritional and psychosocial complications and the optimal body mass index for different ethnic groups exist. The article discusses the major paradigm shift in recent years in the management of T2DM after the introduction of metabolic surgery.

Keywords: Metabolic surgery; Bariatric procedures; Type 2 diabetes mellitus; Body mass index; Diabetes remission

Core tip: Metabolic surgery or bariatric surgery has revolutionised the 21st century management of type 2 diabetes mellitus (T2DM) in obese patients. Marked reduction of body weight following the bariatric procedures results in improvement or remission of T2DM in a significant number of patients along with improvement of other diseases associated with obesity such as hypertension, obstructive sleep apnoea, osteoarthritis and non-alcoholic fatty liver disease. Uncertainty exists about the long-term outcomes in terms of diabetes relapse, nutritional and psychosocial complications. However, the marked benefits of metabolic surgery outweigh the risks related to the procedure that has resulted in a major paradigm shift in the management of obese population with T2DM in recent years which is the topic of discussion of this paper.