Update: Why Diabetes Does Not Resolve in Some Patients after Bariatric Surgery

Abstract

Bariatric surgery provides resolution of co-morbidities of morbid obesity-importantly diabetes type 2. This is initiated by immediate postoperative decrease in intake or assimilation of glucose and is continued by the substantial loss of adipose tissue. Greater weight loss and greater resolution of type 2 diabetes occur after operations that provide rapid passage of nutrients to the hindgut, which likely results in beta-cell stimulation by incretins. Failure of resolution of the diabetes can result from lack of patient compliance, inadequate weight loss, longstanding uncontrolled diabetes, or when the diabetes is actually a type 1.

Bariatric Surgery in Obese Patients With Type 1 Diabetes

“…According to the International Diabetes Federation statement on the role of bariatric surgery in the management of diabetes, fasting insulin, C-peptide, and pancreatic autoantibody status (islet cell and glutamic acid decarboxylase) should be checked before bariatric surgery (47). One of the causes of persisting diabetes after bariatric surgery may be that the patient actually had undiagnosed autoimmune diabetes, not T2D (48). For example, among a group of patients with T1D who had undergone bariatric surgery, one-third of cases were initially diagnosed as having T2D.…”

Bariatric surgery – An update for the endocrinologist

“…Weight trajectories after surgery were significantly different for never remitters, relapsers, and durable remitters (24). Failure of resolution of the diabetes can also result from lack of patient compliance, inadequate weight loss, longstanding uncontrolled diabetes, or when the diabetes is actually a latent autoimune diabetes of the adult (LADA) or a type 1 (25).…”

Synthetic agents in the context of metabolic/bariatric surgery: expanding the scope and impact of diabetes drug discovery

“…Among morbidly obese patients with remission of diabetes at 2 years after metabolic/bariatric surgery involving RYGB, AGB and other procedures, T2D was reported to have reoccurred in 50% by 10 years' follow-up [30,46]. Re-emergence of T2D after metabolic/bariatric surgery has been potentially associated with several preoperative factors, including poor glycemic control, severity of b-cell dysfunction, T2D duration and insulin use as well as a host of postoperative factors, such as maladaptive eating leading to weight regain, time after surgery and definition of clinical T2D remission [51,52]. Even significant, surgically-induced weight loss need not be accompanied by any signs of improved glycemic control whatsoever [53].…”

“…The resolution of T2D after metabolic/bariatric surgery is more likely to occur in diabesity patients whose T2D had been controlled by oral hypoglycemic medications, and poor preoperative glycemic control and insulin use are associated with increased chance of T2D recurrence after surgically improved glucose control [15,51,52]. These results suggest an important role for synthetic drugs in a positive post-surgical prognosis by limiting the degree of preoperative glucose dysregulation.…”

“…Even significant, surgically-induced weight loss need not be accompanied by any signs of improved glycemic control whatsoever [53]. These clinical data substantiate the existence of a substantial number of diabesity patients who had undergone metabolic/ bariatric surgery, yet would still be candidates for medical treatment with synthetic drugs to keep T2D in-check and help maintain glucose homeostasis due to lack of post-surgical T2D resolution.The resolution of T2D after metabolic/bariatric surgery is more likely to occur in diabesity patients whose T2D had been controlled by oral hypoglycemic medications, and poor preoperative glycemic control and insulin use are associated with increased chance of T2D recurrence after surgically improved glucose control [15,51,52]. These results suggest an important role for synthetic drugs in a positive post-surgical prognosis by limiting the degree of preoperative glucose dysregulation.…”