title: An update on the role of bariatric surgery in diabetes management.
abstract: OBJECTIVE
  To review the current state of knowledge on the effects of weight loss (bariatric) surgical procedures in individuals with type 2 diabetes.
  
  
  RESULTS
  Observational and randomized studies provide robust data on the efficacy of bariatric surgery for weight loss and improvement in hyperglycemia. Follow-up information up to 20 years is now available. Surgery offers similar benefits in individuals with BMI 30-35, compared with those with higher BMI. There is a better understanding of the role of gut hormones and nonhormonal factors on weight loss and glucose metabolism. Preoperative factors that predict favorable surgical outcomes have been identified.
  
  
  CONCLUSIONS
  Of commonly performed procedures, adjustable gastric banding has the lowest efficacy for weight loss and diabetes remission and a higher complication rate. Roux-en-Y gastric bypass and sleeve gastrectomy are comparable in terms of efficacy and complications. Remission rates for diabetes range between 40 and 80%; randomized trials show slightly lower remission rates compared with observational studies. At 20 years, approximately 50% of remitters have relapse of diabetes. Complex gut hormonal changes, caloric restriction, and other intestinal factors form the basis for metabolic effects of surgery. Better preoperative β-cell function is the strongest predictor for remission. Long-term follow-up data is still sparse.
authors.affiliation: Diabetes Center of Excellence, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Malkani
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects; D015992:Body Mass Index; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology; D004734:Energy Metabolism; D005768:Gastrointestinal Hormones / Q000378:metabolism; D006801:Humans; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D012074:Remission Induction; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D005768:Gastrointestinal Hormones