Advantage of bariatric surgery for patients with type 2 diabetes mellitus
Authors: Tomoyuki Kawada
Journal: Journal of Hepatology (2014)

Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patientsJournal of HepatologyVol. 60Issue 2PreviewBariatric surgery reduces weight and improves glucose metabolism in obese patients. We investigated the effects of bariatric surgery on hepatic insulin sensitivity. Full-Text PDF Immonen et al. conducted a 6-month follow-up study to assess the effects of bariatric surgery on hepatic insulin sensitivity [[1]Immonen H. Hannukainen J.C. Iozzo P. Soinio M. Salminen P. Saunavaara V. et al.Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patients.J Hepatol. 2014; 60: 377-383Abstract Full Text Full Text PDF PubMed Scopus (82) Google Scholar]. The authors concluded that bariatric surgery showed significant improvement in hepatic insulin sensitivity, expressed by insulin-stimulated hepatic glucose uptake and lowering of endogenous glucose production, in combination with a marked reduction in hepatic volume and fat content in 14 non-diabetic patients and in 9 diabetic patients. In addition, there was no remarkable difference regarding the gain in hepatic insulin sensitivity between data from non-diabetic patients and diabetic patients. Mingrone et al. conducted a randomized, controlled trial to evaluate the advantage of bariatric surgery without medical therapy vs. conventional medical therapy for type 2 diabetes mellitus [[2]Mingrone G. Panunzi S. De Gaetano A. Guidone C. Iaconelli A. Leccesi L. et al.Bariatric surgery vs. conventional medical therapy for type 2 diabetes.N Engl J Med. 2012; 366: 1577-1585Crossref PubMed Scopus (1418) Google Scholar]. The authors examined the data 2 years later, and bariatric surgery resulted in better glucose control than did medical therapy in severely obese patients, defined by a body mass index (BMI) of 35 or higher at baseline, with type 2 diabetes mellitus. In addition, BMI at baseline and the level of weight loss after 2-years did not relate to the improvement in hyperglycemia. Schauer et al. reported that intensive medical therapy plus bariatric surgery (MS therapy) achieved a more desirable glycemic control than medical therapy alone (M therapy) after 3 years in obese patients with uncontrolled type 2 diabetes mellitus [[3]Schauer P.R. Bhatt D.L. Kirwan J.P. Wolski K. Brethauer S.A. Navaneethan S.D. et al.Bariatric surgery vs. intensive medical therapy for diabetes – 3-year outcomes.N Engl J Med. 2014; 370: 2002-2013Crossref PubMed Scopus (1228) Google Scholar], and where the survey had been continued for the same population [4Schauer P.R. Kashyap S.R. Wolski K. Brethauer S.A. Kirwan J.P. Pothier C.E. et al.Bariatric surgery vs. intensive medical therapy in obese patients with diabetes.N Engl J Med. 2012; 366: 1567-1576Crossref PubMed Scopus (1739) Google Scholar, 5Kashyap S.R. Bhatt D.L. Wolski K. Watanabe R.M. Abdul-Ghani M. Abood B. et al.Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment.Diabetes Care. 2013; 36: 2175-2182Crossref PubMed Scopus (230) Google Scholar]. The authors included baseline subjects with a BMI of 27 to 43 and presented a sub-analysis by splitting patients with a body-mass index (BMI) below 35 or higher. As a result, the lowering effect of MS therapy for glycated haemoglobin against M therapy was predominant in patients with a BMI of 35 or higher. In contrast, there is a meta-analysis that shows that bariatric surgery for the treatment of diabetes mellitus in patients with BMI of less than 35 is highly effective, although there are very few randomized trials [6Parikh M. Issa R. Vieira D. McMacken M. Saunders J.K. Ude-Welcome A. et al.Role of bariatric surgery as treatment for type 2 diabetes in patients who do not meet current NIH criteria: a systematic review and meta-analysis.J Am Coll Surg. 2013; 217: 527-532Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 7Maggard-Gibbons M. Maglione M. Livhits M. Ewing B. Maher A.R. Hu J. et al.Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review.JAMA. 2013; 309: 2250-2261Crossref PubMed Scopus (178) Google Scholar]. In fact, the application of bariatric surgery for obese subjects with metabolic disorder sometimes differs among different ethnic populations, and the choice of medical therapy has become wider by the recent development in medical therapy. In addition, metabolic components such as dyslipidemia, hypertension, diabetes mellitus and obesity correlate each other. Furthermore, Courcoulas et al. recently reported that different types of bariatric surgeries showed different effectiveness for the treatment of type 2 diabetes mellitus [[8]Courcoulas A.P. Goodpaster B.H. Eagleton J.K. Belle S.H. Kalarchian M.A. Lang W. et al.Surgical vs. medical treatments for type 2 diabetes mellitus: a randomized clinical trial.JAMA Surg. 2014; 149: 707-715Crossref PubMed Scopus (169) Google Scholar], which has been reviewed by Maggard-Gibbons et al. [[7]Maggard-Gibbons M. Maglione M. Livhits M. Ewing B. Maher A.R. Hu J. et al.Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review.JAMA. 2013; 309: 2250-2261Crossref PubMed Scopus (178) Google Scholar]. From these circumstances, many more randomized controlled studies are required to validate the effect of bariatric surgery in obese patients with type 2 diabetes mellitus. The author declared that he does not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.