The management and prevention of diabetes through lifestyle modifications and weight loss should be the mainstay of therapy in appropriate candidates. Althought over 95% of patients are unable to achieve and maintain any significant weight loss over time. Bariatric surgery for weight loss is an emerging option for more sustainable weight loss in the severely obese subject, especially when obesity is complicated by diabetes or other co-morbidities.
Following bariatric surgery most subjects experience improvements in diabetes control, hypertension, dyslipidemia, and other obesity-related conditions.
In patients with impaired glucose tolerance most studies report 99–100% prevention of progression to diabetes, while in subjects with diabetes prior to surgery, resolution of the disease is reported in 64–93% of the cases.
Reports in the literature on outcomes of bariatric surgery for the treatment of obesity demonstrate accumulating data which indicates not only considerable and sustained weight loss following this type of intervention, but also the associated resolution of obesity-related complications, such as type 2 diabetes, hypertension and dyslipidemia.
Bariatric surgery appears to be an effective and beneficial intervention in patients with diabetes, when medical and nutritional approaches have failed to achieve the desired outcomes. This becomes especially true when metabolic control in these individuals has not been achieved despite aggressive medical therapy. In addition, in obese individuals with pre-diabetes, weight loss through the bariatric approach is clearly an extremely effective intervention to prevent progression to diabetes.
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