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KMID : 1040120170030010057
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Evidence and Values in Healthcare
2017 Volume.3 No. 1 p.57 ~ p.64
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Bariatric/metabolic surgery as an effective antidiabetic treatment in type 2 diabetes mellitus
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Chon Suk
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Abstract
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The optimal treatment of Type 2 diabetes mellitus (T2DM) is still difficult especially in people with obesity, although many kinds of antidiabetic drugs based upon various mechanism have been developed. Recently, bariatric/metabolic surgery shows robust and long term effects on glycemic control and diabetes remission as well as effect on prevention of T2DM. The biliopancreatic diversion, Roux-en-Y gastric bypass, sleeve gastrectomy and adjustable gastric banding have been performed in most of clinical trials. Diabetes remission rate is highest in BPD and lowest in gastric banding. Roux-en-Y gastric bypass is thought to be effective on glucose metabolism with various mechanism. Based on evident results from many clinical trials, many institutes now recommend bariatric/ metabolic surgery for management of obesity in T2DM but physiologic and molecular mechanism of beneficial effect on glycemic control remain incompletely understood. Beyond the weight loss, calorie restriction, glucagon like peptide -1, foregut/hindgut hypothesis and changes of bile acid and gut microbiomes have been suggested for relevant mechanisms of bariatric/metabolic surgery on improvement/remission of T2DM. Further studies to understand the metabolic mechanism of bariatric/metabolic surgery and long term safety in clinical trials help this approaches to use in appropriate subjects.
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KEYWORD
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Bariatric surgery, Metabolic surgery, Type 2 diabetes Mellitus
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