May Surgery be the Treatment of Type 2 Diabetes ?

Bariatric surgery has confirmed its efficacy and safety in treating patients with severe obesity. In such cases, a rapid improvement of diabetes usually occurs, which has led several authors to suggest extending this surgery to patients with diabetes with a moderate increment in weight or to subjects at risk of severe complications such as super-obese adolescents, subjects with diabetes over 55 years with impaired glycaemic equilibrium, women with diabetes or pre-diabetes before pregnancy, or subjects presenting with impaired fasting glucose. However, this raises many unresolved questions regarding the mechanisms involved in the resolution of glycaemic disorders, the risk of a recurrence of diabetes, the onset of nutritional disorders after surgery in pregnant women and older subjects, the risk of peri-operative complications and the efficacy and safety of recent endoluminal techniques. Long-term prospective and randomised studies are therefore necessary to answer questions linked to the use and extension of metabolic surgery.