Narrative Review: Effect of Bariatric Surgery on Type 2 Diabetes Mellitus

doi:10.1059/0003-4819-150-2-200901200-00007

Narrative Review: Effect of Bariatric Surgery on Type 2 Diabetes Mellitus

Marion L. Vetter, MD, RD;
Serena Cardillo, MD;
Michael R. Rickels, MD, MS; and
Nayyar Iqbal, MD, MSCE

From the Hospital of the University of Pennsylvania and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania.

Abstract

Bariatric surgery leads to substantial and durable weight reduction. Nearly 30% of patients who undergo bariatric surgery have type 2 diabetes, and for many of them, diabetes resolves after surgery (84% to 98% for bypass procedures and 48% to 68% for restrictive procedures). Glycemic control improves in part because of caloric restriction but also because gut peptide secretion changes. Gut peptides, which mediate the enteroinsular axis, include the incretins glucagon-like peptide-1 and glucose-dependent insulinotropic peptide, as well as ghrelin and peptide YY. Bariatric surgery (particularly bypass procedures) alters secretion of these gut hormones, which results in enhanced insulin secretion and sensitivity. This review discusses the various bariatric procedures and how they alter the enteroinsular axis. Familiarity with these effects can help physicians decide among the different surgical procedures and avoid postoperative hypoglycemia.

Article and Author Information

Note: Dr. Iqbal is currently an adjunct faculty member at the University of Pennsylvania and is employed at Bristol-Myers Squibb, Lawrenceville, New Jersey.
Acknowledgment: The authors thank Thomas A. Wadden, PhD, for his critical review of the manuscript and James P. Guevara, MD, MPH, for his expertise in qualitative assessment.
Potential Financial Conflicts of Interest: Employment: N. Iqbal (Bristol-Myers Squibb).
Requests for Single Reprints: Marion L. Vetter, MD, RD, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Hospital of the University of Pennsylvania, One Maloney Building, 3400 Spruce Street, Philadelphia, PA 19104; e-mail, marion.vetter{at}uphs.upenn.edu.
Current Author Addresses: Drs. Vetter, Cardillo, Rickels, and Iqbal: Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Hospital of the University of Pennsylvania, One Maloney Building, 3400 Spruce Street, Philadelphia, PA 19104.