561140
research-article2015
SJS0010.1177/1457496914561140Surgery for diabetesA. Maleckas, et al.
REVIEW
Scandinavian Journal of Surgery 0: 1–8, 2015
Surgery in the treatment of type 2 diabetes mellitus A. Maleckas1,2, L. Venclauskas2, V. Wallenius1, H. Lönroth1, L. Fändriks1 1
Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 2 Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Abstract
Background and Aims: The prevalence of diabetes is increasing worldwide, and most of the cases are type 2 diabetes mellitus. The relationship between type 2 diabetes mellitus and obesity is well established, and surgical treatment is widely used for obese patients with type 2 diabetes mellitus. The aim was to present current knowledge about the possible mechanisms responsible for glucose control after surgical procedures and to review the surgical treatment results. Material and Methods: Medical literature was searched for the articles presenting the impact of surgical treatment on glycemic control, long-term results, and possible mechanisms of action among obese individuals with type 2 diabetes mellitus. Results: Remission of type 2 diabetes mellitus after bariatric surgery depends on the definition of the remission used. Complete remission rate after surgery with the new criteria is lower than was considered before. Randomized controlled studies demonstrate that surgery is superior to best medical treatment for the patients with type 2 diabetes mellitus. The recurrence of type 2 diabetes mellitus after bariatric surgery is observed in up to 40% of cases with ≥5 years of follow-up. Despite the recurrence of type 2 diabetes mellitus in this group, better glycemic control and lower risk of macrovascular complications are present. Incretin effects on glycemic control after bariatric surgery are well described, but the role of other possible mechanisms (bile acids, microbiota, intestinal gluconeogenesis) in humans is unclear. Conclusion: Surgery is an effective treatment of type 2 diabetes mellitus in obese patients. The most optimal surgical procedure for the treatment of obese patients with type 2 diabetes mellitus is still to be established. More research is needed to explore the mechanisms of glycemic control after bariatric surgery. Key words: Bariatric surgery; gastric bypass; sleeve gastrectomy; type 2 diabetes mellitus
Correspondence: Almantas Maleckas Department of Surgery Medical Academy Lithuanian University of Health Sciences A. Mickevičiaus g. 9 LT 44307 Kaunas Lithuania Email: [email protected]
2
A. Maleckas, et al.
Introduction There are two main forms of diabetes (1). Type 1 diabetes results in insulin deficiency due to autoimmune-mediated destruction of pancreatic β-cell islets, and exogenous insulin is essential for survival and prevention of ketoacidosis. In type 2 diabetes mellitus (T2DM), either insulin resistance or abnormal insulin secretion may predominate, and if diet alone or oral hypoglycemic agents is not enough for control of blood glucose levels, exogenous insulin may be used. The T2DM accounts for over 90% of all cases. The prevalence of diabetes increases worldwide both in developed and in developing nations, and most of the cases are of T2DM, which is strongly associated with decreased physical activity and obesity (2). The relationship between T2DM and obesity was established by two population-based studies showing that the age-adjusted relative risk of developing T2DM for individuals with a body mass index (BMI) ≥35 kg/ m2 is 93 (95% confidence interval (CI) = 81–107) for women and 42 (95% CI = 22–81) for men as compared with those who had a BMI
research-article2015
SJS0010.1177/1457496914561140Surgery for diabetesA. Maleckas, et al.
REVIEW
Scandinavian Journal of Surgery 0: 1–8, 2015
Surgery in the treatment of type 2 diabetes mellitus A. Maleckas1,2, L. Venclauskas2, V. Wallenius1, H. Lönroth1, L. Fändriks1 1
Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 2 Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Abstract
Background and Aims: The prevalence of diabetes is increasing worldwide, and most of the cases are type 2 diabetes mellitus. The relationship between type 2 diabetes mellitus and obesity is well established, and surgical treatment is widely used for obese patients with type 2 diabetes mellitus. The aim was to present current knowledge about the possible mechanisms responsible for glucose control after surgical procedures and to review the surgical treatment results. Material and Methods: Medical literature was searched for the articles presenting the impact of surgical treatment on glycemic control, long-term results, and possible mechanisms of action among obese individuals with type 2 diabetes mellitus. Results: Remission of type 2 diabetes mellitus after bariatric surgery depends on the definition of the remission used. Complete remission rate after surgery with the new criteria is lower than was considered before. Randomized controlled studies demonstrate that surgery is superior to best medical treatment for the patients with type 2 diabetes mellitus. The recurrence of type 2 diabetes mellitus after bariatric surgery is observed in up to 40% of cases with ≥5 years of follow-up. Despite the recurrence of type 2 diabetes mellitus in this group, better glycemic control and lower risk of macrovascular complications are present. Incretin effects on glycemic control after bariatric surgery are well described, but the role of other possible mechanisms (bile acids, microbiota, intestinal gluconeogenesis) in humans is unclear. Conclusion: Surgery is an effective treatment of type 2 diabetes mellitus in obese patients. The most optimal surgical procedure for the treatment of obese patients with type 2 diabetes mellitus is still to be established. More research is needed to explore the mechanisms of glycemic control after bariatric surgery. Key words: Bariatric surgery; gastric bypass; sleeve gastrectomy; type 2 diabetes mellitus
Correspondence: Almantas Maleckas Department of Surgery Medical Academy Lithuanian University of Health Sciences A. Mickevičiaus g. 9 LT 44307 Kaunas Lithuania Email: [email protected]
2
A. Maleckas, et al.
Introduction There are two main forms of diabetes (1). Type 1 diabetes results in insulin deficiency due to autoimmune-mediated destruction of pancreatic β-cell islets, and exogenous insulin is essential for survival and prevention of ketoacidosis. In type 2 diabetes mellitus (T2DM), either insulin resistance or abnormal insulin secretion may predominate, and if diet alone or oral hypoglycemic agents is not enough for control of blood glucose levels, exogenous insulin may be used. The T2DM accounts for over 90% of all cases. The prevalence of diabetes increases worldwide both in developed and in developing nations, and most of the cases are of T2DM, which is strongly associated with decreased physical activity and obesity (2). The relationship between T2DM and obesity was established by two population-based studies showing that the age-adjusted relative risk of developing T2DM for individuals with a body mass index (BMI) ≥35 kg/ m2 is 93 (95% confidence interval (CI) = 81–107) for women and 42 (95% CI = 22–81) for men as compared with those who had a BMI
