Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Aug 15, 2021; 12(8): 1312-1324
Published online Aug 15, 2021. doi: 10.4239/wjd.v12.i8.1312
Which predictors could effect on remission of type 2 diabetes mellitus after the metabolic surgery: A general perspective of current studies?
Gamze Akkus, Tamer Tetiker
Gamze Akkus, Tamer Tetiker, Department of Internal Medicine, Cukurova University Medical Faculty, Adana 33170, Turkey
Gamze Akkus, Tamer Tetiker, Department of Endocrinology, Cukurova University, Adana 33170, Turkey
Author contributions: Akkus A wrote and edited the manuscript; Tetiker T supervised the preparation of the manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Gamze Akkus, PhD, Academic Research, Department of Endocrinology, Cukurova University Medical Faculty, Sarıcam Street, Adana 33170, Turkey. tugrulgamze@hotmail.com
Received: December 31, 2020
Peer-review started: December 31, 2020
First decision: January 18, 2021
Revised: January 18, 2021
Accepted: April 25, 2021
Article in press: April 25, 2021
Published online: August 15, 2021
Processing time: 221 Days and 3.4 Hours
ARTICLE HIGHLIGHTS
Research background

Metabolic surgery has achieved effective glycemic control in individuals with diabetes and obesity. However, long-term data are limited to show recurrence or remission of hyperglycemia years after the procedure. Moreover, there is limited data on the predictors of remission criteria on type 2 diabetes mellitus (T2DM) after metabolic surgery.

Research motivation

The medical management of T2DM is based on lifestyle modifications and specific glucose-lowering medications. The main purpose is targeted at maintaining glucose levels within an acceptable range, while the former purpose was to achieve weight loss through diet, increased physical activity, and behavioral therapy in order to modulate beneficially the underlying pathophysiology of T2DM. Although most individuals benefit from these conservative approaches in the short term, achieving a sustainable and clinically significant weight loss and its associated metabolic improvement is difficult. The significant effects of bariatric surgery regarding sustained weight loss and metabolic amelioration have gradually drawn attention and highlighted the potential of surgery to serve as a therapeutic modality for T2DM.

Research objectives

In this review, the research objective was to summarize type 2 diabetic patients treated with metabolic surgery. Moreover, all randomized controlled trials studying metabolic surgery were included in the research objectives.

Research methods

All randomized controlled trials, case control trials, or multicenter studies were included in this review. These research studies were evaluated in detail in terms of patients’ demographic characteristics, types of surgical methods, duration times of diabetes, and the period after metabolic surgery.

Research results

The potential benefits of a wide-scale integration of bariatric surgery in standard diabetes care is hindered by the poor penetration that surgical therapeutic options share in T2DM management. However, there is still a lack of data derived from populations of individuals with T2DM. The identification of pre-operative patient-level characteristics may show the highest probability of being refractory or leading to a remission condition after metabolic surgery.

Research conclusions

The number of metabolic surgeries used to treat obesity and T2DM will only increase in the coming years. More studies are needed to test the efficacy and safety of these surgical methods for T2DM. Clinicians should be cognizant of the long term effects on T2DM after metabolic surgery.

Research perspectives

Understanding pathophysiology of durable remission and late relapse could aid patients and the procedure selection process. Further research is needed to study the potential effects bariatric surgery might have on the subsequent remission of diabetes mellitus.