Surgical options in type 2 diabetes

Abstract

The onset of type 2 diabetes is characterized by a nonreversible complex cycle that includes severe deleterious effects on glucose metabolism. Obesity, but mainly visceral adipose tissue accumulation, is an important factor in this process. The goals of diabetes management in clinical practice, despite the improvement over the years, are often not met. In the last 20 years, based on observations of bariatric surgery series that have shown great improvement of type 2 Diabetes in morbid obese patients, metabolic surgery has emerged as a therapeutic possibility. In 2011 the International Diabetes Federation released its position statement mentioning that bariatric surgery was an accepted option for T2DM patients with BMI > 35 kg/m2 and might be considered an alternative therapy for patients with BMI ≤ 35 kg/m2 who do not respond to standard medical therapy. Metabolic/bariatric surgery includes the application of conventional bariatric procedures (Roux-en-Y gastric bypass, biliopancreatic diversion, sleeve gastrectomy) and the introduction of new procedures (ileal interposition, intestinal bipartition) designed with the specific aim of having metabolic effects, irrespective of causing massive weight loss. The reversal of T2DM occurs due to mechanisms such as the increase in insulin sensitivity associated with an improvement in beta-cell function, including recovering the first phase of insulin secretion. This recovery is a consequence of the increase of GLP-1 production, and change in circulating bile acids. Remission of diabetes is observed on the first postoperative days after the operation. © Springer International Publishing Switzerland 2015.