Science, clinical outcomes and the popularization of diabetes surgery.
OBJECTIVE
Bariatric surgery is an important option for the treatment of severe (type III) obesity. Its role in the management of type 2 diabetes in overweight and obese patients needs to be defined.


RESULTS
Intensified medical therapy can achieve target metabolic goals in many but not all patients with type 2 diabetes. Bariatric surgery can normalize or improve glycemia in severely obese patients with type 2 diabetes. The complications of bariatric surgery are significant and include operative mortality, early and late surgical complications and late nutritional deficiencies. Comparative studies of bariatric surgery versus intensive medical therapy in the management and clinical outcomes of patients with type 2 diabetes are needed to evaluate relative risk/benefit of each. Bariatric surgery studies in type 2 diabetes are lacking long-term follow-up metabolic and clinical outcomes data.


CONCLUSIONS
Current data are insufficient to recommend bariatric surgery as a primary treatment for type 2 diabetes. However, it can be recommended for patients whose target metabolic control cannot be achieved by intensive glycemic control because of intolerance or inadequate responses to nutritional and pharmacologic treatments.
State University of New York Health Science Center at Brooklyn, Brooklyn, New York 11203, USA. hlebovitz1@hotmail.com
Harold E
HE
Lebovitz
D050110:Bariatric Surgery / Q000379:methods / Q000401:mortality; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000378:metabolism / Q000401:mortality / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human