The many faces of diabetes. Is there a need for re-classification? A narrative review

Nasser Sakran, Yitka Graham, Tadeja Pintar, Wah Yang, Radwan Kassir, Edith M. Willigendael, Rishi Singhal, Zoë E. Kooreman, Dharmanand Ramnarain, Kamal Mahawar, Chetan Parmar, Brijesh Madhok, Sjaak Pouwels

Research output: Contribution to journalReview articlepeer-review

24 Scopus citations

Abstract

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.

Original languageEnglish
Article number9
JournalBMC Endocrine Disorders
Volume22
Issue number1
DOIs
StatePublished - 7 Jan 2022

Bibliographical note

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Antidiabetic drugs
  • Bariatric surgery
  • Classification
  • Diabetes mellitus
  • Gastrointestinal hormones
  • Metabolic surgery

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