Surgical treatment of type 2 diabetes: the surgeon perspective
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REVIEW
Surgical treatment of type 2 diabetes: the surgeon perspective Alpana P. Shukla • Soo Min Ahn • Rajesh T. Patel Matthew W. Rosenbaum • Francesco Rubino
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Received: 27 May 2011 / Accepted: 21 June 2011 / Published online: 13 August 2011 Ó Springer Science+Business Media, LLC 2011
Abstract Type 2 diabetes mellitus (T2DM) is a major health priority globally, having achieved pandemic status in the twenty-first century. Several gastrointestinal procedures that were primarily designed to treat morbid obesity result in dramatic remission of diabetes. Studies in experimental rodent models and humans have shown that the glycemic benefits of surgery are at least in part weight-independent and extend to non-morbidly obese subjects with T2DM. Bariatric procedures differ in their ability to ameliorate type 2 diabetes, with intestinal bypass procedures being more effective than purely restrictive procedures. Several studies have demonstrated that the benefits of bariatric surgery extend beyond amelioration of hyperglycemia and include improvement in other cardiovascular risk factors such as dyslipidemia and hypertension. The safety and cost-effectiveness of bariatric surgery are also well established by several studies. In this paper, the authors present the surgeon perspective on the management of type 2 diabetes focusing on the efficacy, safety and cost-effectiveness of metabolic surgery. The available evidence warrants the inclusion of metabolic surgery in the treatment algorithm of type 2 diabetes. Keywords Type 2 diabetes mellitus (T2DM) Metabolic surgery Efficacy Safety Cost-effectiveness
A. P. Shukla S. M. Ahn R. T. Patel M. W. Rosenbaum F. Rubino (&) Section of GI Metabolic Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA e-mail: [email protected]
Introduction Type 2 diabetes mellitus (T2DM) is a major health priority globally, having achieved pandemic status in the twentyfirst century. Insulin resistance in muscle and liver and bcell failure represent the core pathophysiologic defects in type 2 diabetes [1]. It is recognized that aggressive glucose lowering with medical therapy prevents microvascular complications although the impact on macrovascular endpoints is modest [2, 3]. The natural history of type 2 DM suggests that insulin secretory capacity declines inexorably over time despite a combination of several pharmacological agents. The resulting worsening of glycemic control and other metabolic factors leads to debilitating consequences: retinopathy, neuropathy, nephropathy, end-stage renal disease and coronary artery disease. Several gastrointestinal procedures that were primarily designed to treat morbid obesity result in dramatic remission of diabetes [4]. Studies in experimental rodent models [5, 6] and humans [7–9] have shown that the glycemic benefits of surgery are at least in part weight-independent and extend to non-morbidly obese subjects with T2DM. This has opened a new chapter in the pathophysiology and m
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