Is it possible to cure diabetes mellitus with bariatric surgery? - Mechanisms of improvement of diabetes by bariatric surgery -

Recently, the results of long-term randomized controlled studies were published comparing the metabolic effects of bariatric surgery with conventional treatment strategies of obesity. Unanimously, these studies demonstrate that bariatric surgery improves glycemic control significantly compared to conventional medical treatment. Rates of diabetes remission range from 95 to 23 % depending on initial patients characteristics, operation method of bariatric surgery and follow-up duration. Is diabetes curable with bariatric surgery? The clear answer is: no, but 1. 35 - 50 % of diabetic patients, achieving diabetes remission after bariatric surgery, had a recurrence of the disease in terms of increasing blood glucose values during the following years. 2. The mean "diabetes-free" time was 8.3 years (range 5 - 15 years). 3. Each year that diabetic patients were in the remission of the disease, was associated with a reduction of the risk of microvascular complications of 19 %. Therefore, bariatric surgery with Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), biliopancreatic diversion (BPD) or newer techniques as omega loop bypass are powerful therapeutic options in the treatment of diabetes and obesity. Bariatric surgery seems to reduce the risk of microvascular diabetic complications. Therefore, bariatric surgery should be involved in the therapeutic strategies as early as possible. It is not definitively clear which type of bariatric operation is the best option for diabetic patients. RYGB seems to have some benefits. The methods of bariatric surgery should be included into the therapeutic armamentarium of each diabetes specialist. The mechanisms of improvement of glycemic control by bariatric surgery will be described in detail according to recent literature data. Indications, contraindications, complications or therapeutic algorithms of bariatric surgery of type 2 diabetes are listed in detail at common guidelines and are not part of this review.