Jalleh RJ, Jones KL, Islam MS, Cai L, Horowitz M. Surgical or medical treatment of obesity-associated type 2 diabetes-an increasing clinical conundrum. World J Diabetes 2024; 15(10): 2036-2040 [PMID: 39493561 DOI: 10.4239/wjd.v15.i10.2036]
Corresponding Author of This Article
Michael Horowitz, DSc, FRACP, MBBS, PhD, Professor, Adelaide Medical School, University of Adelaide, Level 5, AHMS Corner North Tce and George St, Adelaide 5000, Australia. michael.horowitz@adelaide.edu.au
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Oct 15, 2024; 15(10): 2036-2040 Published online Oct 15, 2024. doi: 10.4239/wjd.v15.i10.2036
Surgical or medical treatment of obesity-associated type 2 diabetes-an increasing clinical conundrum
Ryan J Jalleh, Karen L Jones, Md Shahidul Islam, Lu Cai, Michael Horowitz
Ryan J Jalleh, Karen L Jones, Michael Horowitz, Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide; and Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, South Australia, Australia
Md Shahidul Islam, Department of Biochemistry, School of Life Sciences, University of KwaZulu-Natal, Durban 4000, KwaZulu-Natal, South Africa
Lu Cai, Pediatric Research Institute, Departments of Pediatrics, Radiation Oncology, Phar-macology and Toxicology, University of Louisville, Wendy Novak Diabetes Institute, Norton Children’s Hospital, Louisville, KY 40202, United States
Author contributions: Jalleh RJ wrote the original draft; Jones KL, Islam MS, Cai L reviewed and edited it; Horowitz M was the senior author and provided supervision and validation of the writing.
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michael Horowitz, DSc, FRACP, MBBS, PhD, Professor, Adelaide Medical School, University of Adelaide, Level 5, AHMS Corner North Tce and George St, Adelaide 5000, Australia. michael.horowitz@adelaide.edu.au
Received: August 14, 2024 Revised: September 9, 2024 Accepted: September 14, 2024 Published online: October 15, 2024 Processing time: 43 Days and 6.9 Hours
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.
Core Tip: Glucagon-like peptide-1 receptor agonist-based therapy should be considered for the remission of type 2 diabetes and weight loss as an alternative to bariatric surgery.
