April - June 2015, Volume 11, Issue 2

Fica S, Sirbu A

Metabolic Surgery for Dabetes Mellitus between Benefits and Risks

Acta Endo (Buc) 2015, 11 (2): 212-219
doi: 10.4183/aeb.2015.212

The incidence of type 2 diabetes is continuously growing worldwide, with enormous costs for individuals as well as for society. In the last decades, bariatric surgery has emerged as a possible solution for ameliorating metabolic control or even obtaining diabetes remission. Observational trials and metaanalyses demonstrate consistent improvement of type 2 diabetes following various bariatric procedures, but they are generally uncontrolled or they use historic controls as comparators. In recent years, several randomized trials studying the effectiveness of bariatric surgery in type 2 diabetes have been conducted and they all show substantial benefits, with the observation that the majority are shortterm trials. With the increased popularity of diabetes surgery, concerns about its immediate and long-time safety have also grown. The most frequent peri-operative are ulcers or stenosis, obstruction, venous thrombosis, pulmonary embolism and other pulmonary complications, with a mortality of less than 1%. Gastro-intestinal diseases, nutritional deficiencies and psychiatric disorders are the most important longterm problems to be addressed. The uncertainty regarding the long-term effects of bariatric surgery, together with its potential for morbidity and mortality, underline the necessity of large, long-term, randomized clinical trials comparing the best medical therapy with bariatric surgery in patients with type 2 diabetes.

Keywords: bariatric surgery, type 2 diabetes, diabetes remission, nutritional problems

Correspondence: Simona Fica MD, PhD, “Carol Davila” University of Medicine and Pharmacy - Endocrinology, 17 Marasti street, Bucharest, 011461, Romania, E-mail: simonafica@yahoo.com