Mechanism of Metabolic Advantages After Bariatric Surgery

Diabetes Care: August 2013

It’s all gastrointestinal factors versus it’s all food restriction

The acute glucose-lowering effect of certain bariatric procedures—before any significant weight loss has occurred—has been known for decades (1). In a comprehensive meta-analysis by Buchwald et al. (2), type 2 diabetes remission rates after the most common bariatric procedure, Roux-en-Y gastric bypass (RYGB), were reported to be 80%. Applying the 2009 consensus criteria for the definition of diabetes remission has been reported to show complete remission of diabetes in “only” 41% of 160 RYGB-treated obese patients with type 2 diabetes (3). Importantly, bariatric surgery seems to improve several components of the metabolic syndrome, and type 2 diabetes–specific mortality rates have been demonstrated to be up to 90% lower in RYGB-treated subjects compared with nontreated control subjects (2,4). In comparison with medical therapy alone, recent clinical trials have shown that RYGB or biliopancreatic diversion resulted in better glucose control (5), RYGB achieved glycemic control in significantly more patients (6), and sleeve gastrectomy resolved the diabetic state more effectively (7).  Read more