Metabolic Surgery in a Patient with Type 2 Diabetes

Kim, Mi Kyung

Abstract

The prevalence of obesity as well as diabetes is increasing in the world. Korea is in a similar situation. The prevalence of adult diabetes in 2003 was 7.7% but it dramatically increased to 14.4% in 2016 resulting in about 1 in 7 adults having diabetes. Obesity is the main risk factor of diabetes. Patients with diabetes in Korea are more obese than those without diabetes. Therefore, weight reduction is an important treatment factor for diabetic patients. Traditionally, treatment of diabetes includes life style modification based on diet control and exercise and a patient-centered pharmacological approach. In addition to these treatments, recent international guidelines recommend surgical treatment for diabetic patients with class III obesity (body mass index [BMI] >40 kg/m²), regardless of their level of glycemic control or the complexity of their glucose-lowering regimens, and for patients with class II obesity (BMI 35.0 to 39.9 kg/m²) who do not control their glucose despite proper lifestyle modification and pharmacological therapy. Roux-en-Y gastric bypass and sleeve gastrectomy are common procedures for metabolic surgery. A multidisciplinary team approach is important for optimal surgical outcome to assess medical condition, nutrition, mental health, and social support before and after surgery. This article reviews metabolic surgery in patients with diabetes.