The Impact of Bariatric Surgery in Patients with Type-2 Diabetes Mellitus

Richdeep      S. Gill; Arya      M. Sharma; David      P. Al-Adra; Daniel      W. Birch; Shahzeer      Karmali

Abstract

Over 220 million individuals have type-2 diabetes mellitus (T2DM) worldwide. Obesity has been identified as a significant risk factor for the development of T2DM. Overweight or obese individuals develop insulin resistance with resultant hyperinsulinemia. This process may progress to impaired glucose intolerance and eventual T2DM. There is strong evidence indicating that bariatric surgery may produce sustainable long-term weight loss in obese individuals. Bariatric surgery consists of surgical operations classified as either primarily restrictive or malabsorptive. Restrictive bariatric procedures include gastric banding or sleeve gastrectomy, while malabsorptive procedures included gastric bypass and biliopancreatic diversion. Malabsorptive procedures have been shown to be superior in producing dramatic weight loss along with resolution or improvement of T2DM. Interestingly, improvement of diabetes has been shown to occur shortly following malabsorptive bariatric surgery, prior to significant weight loss, suggesting that hormone-mediated mechanisms may be involved. As the prevalence of obesity and T2DM continues to rise, so may the role of bariatric surgery to combat this growing epidemic.

Keywords: Obesity, Type 2 diabetes mellitus, Bariatric surgery, Metabolic surgery, Gastric banding (LAGB), Sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), Biliopancreatic diversion (BPD), Body mass index (BMI), Insulin sensitivity