Bariatric surgery in patients with late-stage type 2 diabetes: expected beneficial effects on risk ratio and outcomes

The objective of this review was to assess the safety and efficacy of bariatric surgery in patients with severe obesity and late-stage type 2 diabetes (T2D).

A review of the literature looked for reported data on outcomes of bariatric surgery when performed in patients with T2D treated by oral medications or insulin. Recent updates in our understanding of the effects of bariatric surgery on glucose homoeostasis were also examined.

Data on the outcomes of bariatric surgery in advanced T2D are scarce. Having either T2D for more than 10 years or more advanced forms of the disease, according to antidiabetic therapy, is associated with less weight loss after bariatric surgery. Improvement of diabetes control is also less than seen in earlier forms of T2D, and resolution of the disease is less likely to occur. However, a reduction in oral medications or insulin doses has been documented. Residual beta-cell function is suggested to be a possible determining factor for therapeutic changes or cessation, while reductions in both weight-related and non-weight-related insulin resistance can be expected. Beneficial effects on co-morbidities and overall mortality due to the excess weight loss may also be seen.

Bariatric surgery in patients with severe obesity and late-stage T2D is currently justified by the expected benefits due to the excess weight loss. However, specific studies are needed to better assess the effects of such surgery on glucose control and the associated outcomes.