Published online Aug 15, 2021. doi: 10.4239/wjd.v12.i8.1312
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
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.
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.
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.
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.
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.
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.
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.