Bariatric Surgery

Bariatric surgery is now an established method to reduce body weight in subjects with extreme obesity (> 40kg/m2), and there is growing consensus that this method can also be applied in subjects with type 2 diabetes at a group of patients surgery is by far the most effective treatment mode with excellent long-term results compared to all other methods. In the Swedish Obese Subjects (SOS) study, a large prospective trial comparing bariatric surgery with conventional dietary treatment, sustained weight loss > 20 kg was exclusively achieved in the operated subjects with practically no significant weight change in the control group. Analysis of the data revealed that the 10-year cumulative incidence of diabetes and of other cardiovascular risk factors with the exception of hypertension was reduced by up to 80% in the operated group compared to the control group (50). Other studies have shown that bariatric surgery of extremely obese subjects with clinical diabetes is associated with a dramatic improvement in glycemic control. In up to 80% of the operated patients insulin treatment was no longer required after substantial weight loss and all other medications for diabetes and other cardiovascular risk factors could be considerably reduced or discontinued (51). In another analysis from the same group, sustained weight reduction in obese type 2 diabetic subjects was associated with a remarkable lower mortality and healthcare utilization compared to patients on the waiting list (52).

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