Diabetes surgery is a new concept in recent years, which means controlling blood sugar or curing diabetes through some surgical methods. From the commencement of bariatric surgery in the 1950s to the discovery of the special function of decreasing blood sugar after these surgeries in 1970s, and then the fast developing of diabetes surgery in the past 30 years, now there seems be a different answer to the question that if we can cure diabetes. In this article, we review the historical evolution, surgical procedure, potential mechanism and outlook of diabetes surgery.
Bariatric Surgery ; methods ; Diabetes Mellitus, Type 2 ; surgery ; Humans

Patients with type 2 diabetes mellitus experience a complete and comfirm diabetic remission after bariatric surgery. Although weight-loss, reduction of food intake and other factors may play important roles in diabetic resolution after bariatric surgery, the major mechanism is the change in gastrointestinal hormones. Further research is essential to better understand these mechanisms and bariatric surgery may ultimately become a major tool in the treatment of type 2 diabetes mellitus.
Bariatric Surgery ; Diabetes Mellitus, Type 2 ; physiopathology ; surgery ; Humans

A large number of clinical studies indicate that bariatric surgery leads to improvement or resolution of type 2 diabetes. The outcomes vary depending on procedure adopted. Biliopancreatic diversion(BPD) is associated with the highest cure rate(98%), followed by Roux-en-Y gastric bypass(RGBP)(80%). However, the mechanism is still unclear and controversial. The changes of many hormones after surgery are different between BPD and RGBP, especially some gastrointestinal hormones such as GLP-1 and GIP,however it cannot be fully explained by the widely known hindgut hypothesis and the foregut hypothesis. This review is intended to compare the anatomical structures and postoperative gastrointestinal hormones GLP-1 and GIP changes between the two procedures according to the latest researches in the world, and discussed different mechanisms which may take effect in improving diabetes.
Biliopancreatic Diversion ; Diabetes Mellitus, Type 2 ; surgery ; Gastric Bypass ; Humans

PURPOSE: Metabolic surgery has been performed as a treatment option for uncontrolled type 2 diabetes (T2D), and several scoring systems for predicting postoperative T2D remission have been proposed. This study was designed to assess consistency of 3 existing scoring systems in patients with T2D duration <1 year. METHODS: This study included 186 patients with T2D enrolled in a university hospital prospective database between 2011 and 2013. Externally validated scoring systems for predicting T2D prognosis after metabolic surgery were identified and selected through systematic literature search. We assessed concordance between ABCD, DiaRem, and individualized metabolic surgery (IMS) scores in participants using kappa statistical analysis and 1-way analysis of variance. RESULTS: Of the participants, 52 and 82 patients were expected to have favorable T2D remission after metabolic surgery with ABCD score of 10–5 and DiaRem score of 0–7, respectively, and a slight-to-fair concordance was shown between the 2 scoring systems (kappa measure, 0.07; standard error [SE], 0.05 and kappa measure, 0.25; SE, 0.19, respectively). The DiaRem score increased with T2D severity determined by IMS score (P < 0.001), while the ABCD score showed no significant association with IMS score. CONCLUSION: ABCD and DiaRem scores showed significant discordance when applied to potential metabolic surgery candidates in whom postoperative T2D remission rate was highly expected. The IMS score showed a dose-response association with DiaRem score but had no significant association with the ABCD score.
Bariatric Surgery ; Diabetes Mellitus, Type 2 ; Humans ; Prognosis ; Prospective Studies

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases and public health problems. Roux-en-Y gastric bypass (RYGB) can rapidly, effectively and sustainably improve glycemic control in morbidly obese patients with T2DM. However, the mechanisms of glycemic control after RYGB are still unclear now. Duodenal-jejunal bypass (DJB) is an improved RYGB sparing intact stomach, which is mainly used to investigate the mechanisms of RYGB to treat T2DM. DJB has also been used to treat non-obese T2DM patients. In the present article, we review the results and mechanisms of DJB to treat T2DM on the basis of the previous studies to further elucidate the mechanisms of RYGB in the management of T2DM.
Diabetes Mellitus, Type 2 ; surgery ; Duodenum ; surgery ; Gastric Bypass ; Humans ; Jejunum ; surgery

After more than half a century of development, obesity and metabolic surgery in western countries has become a complete surgical specialties, but the introduction of obesity and metabolic surgery was only 10 years old in China. The surgical treatment of obesity and related metabolic diseases, especially obesity of type 2 diabetes has been recognized and acknowledgd by the majority of surgical colleagues and patients as a new direction of development. The current trend of obesity and metabolic surgery is favorable, but there are many problems in the development of obesity and metabolic surgery in China, for example, the surgery nomenclature is not standardized, surgical indications are loosened, the surgical procedure is modified arbitrarily, the evaluation criteria is confusing, the postoperative follow-up protocol is not unified, etc. These problems require the majority of surgical colleagues to work together to make the standards scientifically a nd objectively in accordance with the actual situatioin of our country, so as to promote the healthy development of obesity and metabolic surgery in China.
Bariatric Surgery ; methods ; standards ; Diabetes Mellitus, Type 2 ; surgery ; Humans ; Obesity ; surgery

Diabetes Mellitus, Type 2 ; complications ; drug therapy ; surgery ; Humans ; Obesity ; complications ; drug therapy ; surgery

The median body mass index(BMI) of patients with type 2 diabetes mellitus(T2DM) in China is only 24 kg/m(2) and diabetic diet in China is different from that in the Western countries. Currently there are no sufficient weight loss surgery data and guidance in China. Therefore, aside from the internationally recognized surgical procedures, Chinese surgeons have been trying to find other suitable procedures for T2DM. In 2011, operations for treatment of T2DM recommended by the International Diabetes Federation(IDF) are as follow: gastric bypass surgery(GBP), sleeve gastrectomy(SG), bile pancreatic surgery(BPD), duodenal inversion technique(DS) and the adjustable gastric band surgery(AGB). At present, the main exploratory surgery procedures in China include: sleeve gastrectomy and duodenal-jejual bypass, duodenal-jejual bypass, sleeve gastrectomy and jejual-ileal bypass, sleeve gastrectomy and ileal interposition, ileal interposition, jejunal-ileal bypass, gastric folding technique, gastric folding and banding, and other weight loss surgery under endoscopy. Each operation has different characteristics, but the optimal surgery for patients with T2DM still needs long term follow-up and large sample of multi-center clinical research. We believe that under the scientific standardization, surgeons in China will develop the most suitable procedures for patients with T2DM.
Bariatric Surgery ; Body Mass Index ; China ; Diabetes Mellitus, Type 2 ; surgery ; Gastrectomy ; Humans ; Ileum ; Weight Loss

Gastric surgery can reduce the body weight in obese patients with type 2 diabetes and decrease their blood glucose. In the latter, incretins may play certain roles.
Diabetes Mellitus, Type 2 ; etiology ; surgery ; Gastric Bypass ; Humans ; Obesity, Morbid ; complications ; surgery ; Treatment Outcome

In 2001, Rutledge reported the first case of mini gastric bypass (MGB). Carbajo improved the technique of MGB and named it one anastomosis gastric bypass (OAGB). Over the past 20 years, a large number of clinical and basic studies on OAGB/MGB have been reported, and the answers to some key questions about OAGB/MGB have gradually become clear. From a technical point of view, MGB and OAGB can be regarded as two subvariants of one surgery. The advantages of OAGB/MGB include: (1) simplicity, safety and lower probability of internal hernia;(2) stable and durable weight reduction effect; (3) stable and durable remission rate of type 2 Diabetes. The disadvantages of OAGB/MGB include: (1) bile reflux; (2) higher risk of malnutrition. OAGB/MGB has achieved a good balance between effectiveness and safety, and has become the most noticed and fastest-growing bariatric and metabolic procedure in recent years. OAGB/MGB has been recommended as a standard bariatric and metabolic procedure by IFSO and ASMBS.
Diabetes Mellitus, Type 2/surgery* ; Gastric Bypass/methods* ; Humans ; Obesity, Morbid/surgery* ; Retrospective Studies ; Weight Loss