Prevention Is Better Than Cure: The Next Frontier for Bariatric Surgery?
Authors: Carel W. le Roux, Philip R. Schauer
Journal: Annals of Internal Medicine (2018)

Editorials4 September 2018Prevention Is Better Than Cure: The Next Frontier for Bariatric Surgery?Carel W. le Roux, MD, PhD and Philip R. Schauer, MDCarel W. le Roux, MD, PhDDiabetes Complications Research Centre, University College Dublin, Dublin, Ireland (C.W.L.)Search for more papers by this author and Philip R. Schauer, MDCleveland Clinic Lerner College of Medicine, Cleveland, Ohio (P.R.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2114 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Patients with type 2 diabetes mellitus (T2DM) do not die of hyperglycemia; instead, the complications of this multisystem disease drive morbidity and mortality. The trend toward earlier-onset diabetes significantly magnifies concern. Until recently, T2DM was considered a chronic and progressive disease. With better pharmacotherapy and the widely endorsed use of bariatric surgery to treat T2DM specifically, level 1 evidence indicates that surgery not only attenuates disease progression but also often induces remission of hyperglycemia (1–3). The question is whether bariatric surgery improves only hyperglycemia or fundamentally changes the course of the disease.O'Brien and colleagues (4) addressed this question by ...References1. Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, et al; Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39:861-77. [PMID: 27222544] doi:10.2337/dc16-0236 CrossrefMedlineGoogle Scholar2. American Diabetes Association. 7. Obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes—2018. Diabetes Care. 2018;41:S65-S72. [PMID: 29222378] doi:10.2337/dc18-S007 CrossrefMedlineGoogle Scholar3. Schauer PR, Mingrone G, Ikramuddin S, Wolfe B. Clinical outcomes of metabolic surgery: efficacy of glycemic control, weight loss, and remission of diabetes. Diabetes Care. 2016;39:902-11. [PMID: 27222548] doi:10.2337/dc16-0382 CrossrefMedlineGoogle Scholar4. O'Brien R, Johnson E, Haneuse S, Coleman KJ, O'Connor PJ, Fisher DP, et al. Microvascular outcomes in patients with diabetes after bariatric surgery versus usual care. A matched cohort study. Ann Intern Med. 2018;169:300-10. doi:10.7326/M17-2383 LinkGoogle Scholar5. Zhou X, Li L, Kwong JS, Yu J, Li Y, Sun X. Impact of bariatric surgery on renal functions in patients with type 2 diabetes: systematic review of randomized trials and observational studies. Surg Obes Relat Dis. 2016;12:1873-82. [PMID: 27421689] doi:10.1016/j.soard.2016.05.003 CrossrefMedlineGoogle Scholar6. Nair M, leRoux CW, Docherty NG. Measuring changes in renal function after bariatric surgery: why estimated glomerular filtration rate is not good enough [Editorial]. Surg Obes Relat Dis. 2016;12:1897-8. [PMID: 27998545] doi:10.1016/j.soard.2016.03.027 CrossrefMedlineGoogle Scholar7. Friedman AN, Wahed AS, Wang J, Courcoulas AP, Dakin G, Hinojosa MW, et al. Effect of bariatric surgery on CKD risk. J Am Soc Nephrol. 2018;29:1289-300. [PMID: 29335242] doi:10.1681/ASN.2017060707 CrossrefMedlineGoogle Scholar8. Shulman A, Peltonen M, Sjöström CD, Andersson-Assarsson JC, Taube M, Sjöholm K, et al. Incidence of end-stage renal disease following bariatric surgery in the Swedish Obese Subjects Study. Int J Obes (Lond). 2018;42:964-73. [PMID: 29568103] doi:10.1038/s41366-018-0045-x CrossrefMedlineGoogle Scholar9. Kim YJ, Kim BH, Choi BM, Sun HJ, Lee SJ, Choi KS. Bariatric surgery is associated with less progression of diabetic retinopathy: a systematic review and meta-analysis. Surg Obes Relat Dis. 2017;13:352-60. [PMID: 27919835] doi:10.1016/j.soard.2016.10.002 CrossrefMedlineGoogle Scholar10. Fioretto P, Steffes MW, Sutherland DE, Goetz FC, Mauer M. Reversal of lesions of diabetic nephropathy after pancreas transplantation. N Engl J Med. 1998;339:69-75. [PMID: 9654536] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland (C.W.L.)Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio (P.R.S.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2114.Corresponding Author: Philip R. Schauer, MD, 9500 Euclid Avenue, Cleveland, OH 44195; e-mail, [email protected]org.Current Author Addresses: Dr. Schauer: 9500 Euclid Avenue, Cleveland, OH 44195.Dr. le Roux: Conway Institute, University College Dublin, Dublin 4, Ireland.This article was published at Annals.org on 7 August 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMicrovascular Outcomes in Patients With Diabetes After Bariatric Surgery Versus Usual Care Rebecca O'Brien , Eric Johnson , Sebastien Haneuse , Karen J. Coleman , Patrick J. O'Connor , David P. Fisher , Stephen Sidney , Andy Bogart , Mary Kay Theis , Jane Anau , Emily B. Schroeder , and David Arterburn Metrics Cited byBariatric Surgery in the Treatment of Type 2 DiabetesStandardized Uniform Reporting and Indications for Bariatric and Metabolic Surgery 4 September 2018Volume 169, Issue 5Page: 343-344KeywordsBariatric surgeryCohort studiesCreatinineHyperglycemiaKidneysNeuropathyRetinopathySurgeryType 2 diabetesWeight loss ePublished: 7 August 2018 Issue Published: 4 September 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...