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A British study published this year demonstrates the beneficial effects of bariatric surgery in type 2 diabetics with obesity.

 

1| The overall benefits of bariatric surgery in the treatment of obese patients with type 2 diabetics

Type 2 diabetes and obesity are major public health issues worldwide. The prevalence of these diseases is rising rapidly, with the International Diabetes Federation forecasting that, by 2040, 1 in 10 people will be affected by type 2 diabetes.1

Diabetes and obesity adversely affect both the renal and cardiovascular systems. Obesity very often causes insulin resistance, hyperglycemia and high blood pressure, all risk factors for the development of chronic cardiovascular and kidney diseases. Bariatric surgery may be an alternative treatment option for some patients with both type 2 diabetes and obesity. In addition to weight loss, bariatric surgery offers major benefits in terms of metabolic and blood glucose control.2

The surgery can even lead to complete remission of diabetes. A Swedish study demonstrates a reduction in mortality and a reduction in the incidence of vascular complications in diabetic patients having undergone bariatric surgery, with a remission rate of over 30% after 15 years.3

 

2| The specific effects of bariatric surgery on the kidneys and heart of obese patients with type 2 diabetics

A recent British study including 11,125 patients with type 2 diabetes was carried out to demonstrate the renal and cardiovascular effects of bariatric surgery. The study concerned two cohorts, one including patients having undergone bariatric surgery and the other including patients without this surgery. The mean age of the first group was 52 years, with around 60% women and a body mass index (BMI) of 41. For this cohort, the scientists observed a 54% reduction in the development of chronic kidney disease (CKD) compared to the cohort without bariatric surgery. The scientists also observed that the bariatric group had an increased glomerular filtration rate, i.e., an increased 24-hour filtration capacity of the kidneys during 75% of the follow-up time. It was also observed that patients with microalbuminuria at baseline were protected against CKD.4

Bariatric surgery is still not often routinely considered despite its potential benefits in terms of reducing some of the complications of type 2 diabetes. Additional randomized studies are likely to further confirm the benefits of this type of surgery.

 

3| Sources

  1. https://www.diabetesatlas.org/en/
  2. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995; 222(3):339-352. doi:10.1097/00000658-199509000-00011
  3. Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297-2304. doi:10.1001/jama.2014.5988
  4. Alkharaiji, M., Anyanwagu, U., Donnelly, R. et al. Effect of Bariatric Surgery on Diagnosed Chronic Kidney Disease and Cardiovascular Events in Patients with Insulin-treated Type 2 Diabetes: a Retrospective Cohort Study from a Large UK Primary Care Database. OBES SURG 30, 1685–1695 (2020). https://doi.org/10.1007/s11695-019-04201-y