Benefits of bariatric surgery on glycemic control in patients with type 2 diabetes mellitus. A narrative review.

Abstract

Introduction and purposes:

Obesity is a critical global health challenge, closely linked to a range of serious conditions, including metabolic syndrome, insulin resistance, and an increased likelihood of developing type 2 diabetes. Affecting over two billion people worldwide, obesity necessitates a multifaceted approach to treatment, encompassing lifestyle changes, pharmaceutical interventions, and surgical procedures. Among the surgical options, bariatric surgeries such as sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are particularly prominent.

Materials and Methods: A systematic literature search was conducted using PubMed and Google Scholar. The search employed terms such as 'glycemia', 'bariatric surgery', ‘metabolic surgery’ 'RYGB', 'diabetes type 2’, ‘Postprandial hyperinsulinemic hypoglycemia’ 'hypoglycemia' ‘dumping syndrome’.  Articles published between 2019 and 2024 were included in the search.

Results: Bariatric surgery is well-documented for its significant impact on glycemic control and overall physical health, resulting in substantial reductions in both HbA1c levels and BMI. Remarkably, many patients with type 2 diabetes achieve remission of the disease following surgery, regardless of their pre-surgery BMI. However, the enhanced glycemic control achieved through bariatric procedures can also lead to an increased risk of developing postprandial hyperinsulinemic hypoglycemia (PHH). This condition arises as a complication from the surgery, where blood sugar levels drop excessively after meals due to an overproduction of insulin.

Conclusion: Despite this potential risk, the overall benefits of bariatric surgery in managing and potentially reversing type 2 diabetes are profound.