Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Editorial
. 2024 Oct 15;15(10):2036-2040.
doi: 10.4239/wjd.v15.i10.2036.

Surgical or medical treatment of obesity-associated type 2 diabetes-an increasing clinical conundrum

Ryan J Jalleh  1 , Karen L Jones  1 , Md Shahidul Islam  2 , Lu Cai  3 , Michael Horowitz  4
Affiliations
Editorial

Surgical or medical treatment of obesity-associated type 2 diabetes-an increasing clinical conundrum

Ryan J Jalleh et al. World J Diabetes. .

Abstract

In this editorial, we comment on the article by He et al, specifically in relation to the efficacy of bariatric surgery vs glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy in the management of type 2 diabetes (T2D) associated with obesity. Bariatric surgery has now also been shown to be safe and effective in pre-teens and teenagers with obesity and T2D, but information on newer GLP-1RAs in these groups is predictably limited. In older individuals (age > 65 years), both bariatric surgery and GLP-1RA therapy improve cardiovascular outcomes. Bariatric surgery is not infrequently associated with post-operative postprandial hypoglycemia, which is not the case with GLP-1RAs and, paradoxically, there is evidence that GLP-1RAs may reduce both the frequency and severity of postprandial hypoglycemia. Comparative trials of the long-term efficacy of bariatric surgery and GLP-1RAs are indicated.

Keywords: Bariatric surgery; Diabetes; Glucagon-like peptide-1; Glucagon-like peptide-1 receptor agonist; Hypoglycemia; Metabolic surgery; Obesity; Weight loss.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: Jones KL has previously received research funding from Sanofi-Aventis and AstraZeneca; participated on an advisory board for Glyscend Therapeutics (without receipt of payment); and declares stock options, but does not own any stock, in Glyscend Therapeutics. Horowitz M declares stocks in Mirum Pharmaceuticals, a company that owns Livmarli (maralixibat), which is approved in the United States and Europe for the treatment of cholestatic pruritus in Alagille syndrome (a genetic liver disorder). Mirum Pharmaceuticals has work underway related to rare liver diseases, but not diabetes or obesity. Horowitz M declares stock options, but does not own any stock, in Glyscend Therapeutics; and is a member of the scientific and clinical advisory board for Glyscend Therapeutics. All other authors declare no competing interests.

References

    1. He YF, Hu XD, Liu JQ, Li HM, Lu SF. Bariatric surgery and diabetes: Current challenges and perspectives. World J Diabetes. 2024;15:1692–1703. - PMC - PubMed
    1. Patti ME, Goldfine AB. Hypoglycaemia following gastric bypass surgery--diabetes remission in the extreme? Diabetologia. 2010;53:2276–2279. - PubMed
    1. Courcoulas AP, Patti ME, Hu B, Arterburn DE, Simonson DC, Gourash WF, Jakicic JM, Vernon AH, Beck GJ, Schauer PR, Kashyap SR, Aminian A, Cummings DE, Kirwan JP. Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes. JAMA. 2024;331:654–664. - PMC - PubMed
    1. Sandoval DA, Patti ME. Glucose metabolism after bariatric surgery: implications for T2DM remission and hypoglycaemia. Nat Rev Endocrinol. 2023;19:164–176. - PMC - PubMed
    1. Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365:1597–1604. - PubMed

Publication types

LinkOut - more resources