TY - JOUR
T1 - The many faces of diabetes. Is there a need for re-classification? A narrative review
AU - Sakran, Nasser
AU - Graham, Yitka
AU - Pintar, Tadeja
AU - Yang, Wah
AU - Kassir, Radwan
AU - Willigendael, Edith M.
AU - Singhal, Rishi
AU - Kooreman, Zoë E.
AU - Ramnarain, Dharmanand
AU - Mahawar, Kamal
AU - Parmar, Chetan
AU - Madhok, Brijesh
AU - Pouwels, Sjaak
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2022/1/7
Y1 - 2022/1/7
N2 - The alarming rise in the worldwide prevalence of obesity and associated type 2 diabetes mellitus (T2DM) have reached epidemic portions. Diabetes in its many forms and T2DM have different physiological backgrounds and are difficult to classify. Bariatric surgery (BS) is considered the most effective treatment for obesity in terms of weight loss and comorbidity resolution, improves diabetes, and has been proven superior to medical management for the treatment of diabetes. The term metabolic surgery (MS) describes bariatric surgical procedures used primarily to treat T2DM and related metabolic conditions. MS is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Originally, BS was used as an alternative weight-loss therapy for patients with severe obesity, but clinical data revealed its metabolic benefits in patients with T2DM. MS is more effective than lifestyle or medical management in achieving glycaemic control, sustained weight loss, and reducing diabetes comorbidities. New guidelines for T2DM expand the use of MS to patients with a lower body mass index. Evidence has shown that endocrine changes resulting from BS translate into metabolic benefits that improve the comorbid conditions associated with obesity, such as hypertension, dyslipidemia, and T2DM. Other changes include bacterial flora rearrangement, bile acids secretion, and adipose tissue effect. This review aims to examine the physiological mechanisms in diabetes, risks for complications, the effects of bariatric and metabolic surgery and will shed light on whether diabetes should be reclassified.
AB - The alarming rise in the worldwide prevalence of obesity and associated type 2 diabetes mellitus (T2DM) have reached epidemic portions. Diabetes in its many forms and T2DM have different physiological backgrounds and are difficult to classify. Bariatric surgery (BS) is considered the most effective treatment for obesity in terms of weight loss and comorbidity resolution, improves diabetes, and has been proven superior to medical management for the treatment of diabetes. The term metabolic surgery (MS) describes bariatric surgical procedures used primarily to treat T2DM and related metabolic conditions. MS is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Originally, BS was used as an alternative weight-loss therapy for patients with severe obesity, but clinical data revealed its metabolic benefits in patients with T2DM. MS is more effective than lifestyle or medical management in achieving glycaemic control, sustained weight loss, and reducing diabetes comorbidities. New guidelines for T2DM expand the use of MS to patients with a lower body mass index. Evidence has shown that endocrine changes resulting from BS translate into metabolic benefits that improve the comorbid conditions associated with obesity, such as hypertension, dyslipidemia, and T2DM. Other changes include bacterial flora rearrangement, bile acids secretion, and adipose tissue effect. This review aims to examine the physiological mechanisms in diabetes, risks for complications, the effects of bariatric and metabolic surgery and will shed light on whether diabetes should be reclassified.
KW - Antidiabetic drugs
KW - Bariatric surgery
KW - Classification
KW - Diabetes mellitus
KW - Gastrointestinal hormones
KW - Metabolic surgery
UR - http://www.scopus.com/inward/record.url?scp=85122388950&partnerID=8YFLogxK
U2 - 10.1186/s12902-021-00927-y
DO - 10.1186/s12902-021-00927-y
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C2 - 34991585
AN - SCOPUS:85122388950
SN - 1472-6823
VL - 22
JO - BMC Endocrine Disorders
JF - BMC Endocrine Disorders
IS - 1
M1 - 9
ER -