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Assessing the obese diabetic patient for bariatric surgery: which candidate do I choose?

Authors Raffaelli M, Sessa L, Mingrone G, Bellantone R

Received 15 August 2014

Accepted for publication 23 March 2015

Published 8 June 2015 Volume 2015:8 Pages 255—262

DOI https://doi.org/10.2147/DMSO.S50659

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Ming-Hui Zou

Marco Raffaelli,1 Luca Sessa,1 Geltrude Mingrone,2 Rocco Bellantone1

1Division of Endocrine and Metabolic Surgery, 2Division of Obesity Diseases, Università Cattolica del Sacro Cuore, Rome, Italy

Abstract: The worldwide prevalence of type 2 diabetes is rising in association with an increasing frequency of overweight and obesity. Bariatric-metabolic procedures are considered as additional therapeutic options, allowing improved diabetes control in most patients. Multiple factors play in concert to achieve the improvements in diabetic remission observed after bariatric-metabolic surgery. Several studies have demonstrated that bariatric-metabolic surgery is an effective treatment for type 2 diabetes when compared with conventional nonsurgical medical treatment. Because the best results are achievable in patients with a relatively short history of diabetes and less advanced controlled disease, the surgical option could be considered early, especially in morbid obese subjects (BMI ≥35 kg/m2) after failure of medical treatment. Patients with extensive weight loss are more likely to achieve type 2 diabetes remission after bariatric surgery. At present, Roux-en-Y gastric bypass seems the surgical procedure of choice because it has fewer risks than biliopancreatic diversion, and it is associated with higher weight loss and metabolic improvements compared with adjustable gastric banding. Recent evidences regarding the effectiveness of sleeve gastrectomy in diabetes remission have to be confirmed by controlled trials with longer follow-up.

Keywords: bariatric surgery, metabolic surgery, diabetes, morbid obesity

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