Mondal S, Ambrose Fistus V, Pappachan JM. Bariatric and endo-bariatric interventions for diabetes: What is the current evidence? World J Diabetes 2024; 15(11): 2255-2263 [PMID: 39582566 DOI: 10.4239/wjd.v15.i11.2255]
Corresponding Author of This Article
Joseph M Pappachan, MD, FRCP, Academic Editor, Consultant Endocrinologist, Professor, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston PR2 9HT, Lancashire, United Kingdom. drpappachan@yahoo.co.in
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Letter to the Editor
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. Nov 15, 2024; 15(11): 2255-2263 Published online Nov 15, 2024. doi: 10.4239/wjd.v15.i11.2255
Bariatric and endo-bariatric interventions for diabetes: What is the current evidence?
Sunetra Mondal, Vanessa Ambrose Fistus, Joseph M Pappachan
Sunetra Mondal, Department of Endocrinology, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India
Vanessa Ambrose Fistus, Department of Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, Lancashire, United Kingdom
Joseph M Pappachan, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, Lancashire, United Kingdom
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
Joseph M Pappachan, Department of Endocrinology, Kasturba Medical College, Manipal University, Manipal 576104, India
Co-first authors: Sunetra Mondal and Vanessa Ambrose Fistus.
Author contributions: Mondal S and Fistus VA contributed to the initial drafting of the work by performing the literature search and interpretation of relevant literature; Mondal S also initially prepared the figures for the manuscript and contributed substantially in addition to the revision process; Pappachan JM conceptualized the idea and provided overall supervision to the drafting process and figure preparation; all authors contributed to the revision of the article for important intellectual content; all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Joseph M Pappachan, MD, FRCP, Academic Editor, Consultant Endocrinologist, Professor, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston PR2 9HT, Lancashire, United Kingdom. drpappachan@yahoo.co.in
Received: August 1, 2024 Revised: September 11, 2024 Accepted: September 18, 2024 Published online: November 15, 2024 Processing time: 76 Days and 14.4 Hours
Abstract
Bariatric interventions have shown the best therapeutic benefits in individuals with obesity. They can be classified into surgical procedures (bariatric/metabolic surgery) and endoscopic procedures. Common surgical procedures include sleeve gastrectomy, Roux-en-Y gastric bypass, bilio-pancreatic diversion with or without duodenal switch and Stomach Intestinal Pylorus Sparing Surgery. Endoscopic procedures include intragastric balloons, transpyloric shuttle, endoscopic gastroplasties, aspiration therapy, duodenal mucosal resurfacing, duodeno-jejunal bypass liner, gastro-duodeno-jejunal bypass and incisionless magnetic anastomosis system among others. However, these procedures are limited by lack of wide availability, high costs, immediate and long-term complications and poor acceptability in some regions. Weight re-gain is a common concern and revisional metabolic surgery is often required. Appropriate pre-operative evaluation and correction of nutritional deficiencies post-surgery are very important. The most appropriate procedure for a person would depend on multiple factors like the intended magnitude of weight-loss, comorbidities and surgical fitness, as well as choice of the patient. Recently, glucagon-like insulinotropic peptide-1 receptor agonists (GLP) and the GLP-1/gastric inhibitory polypeptide co-agonist–Tirzepatide have shown remarkable weight loss potential, which is at par with bariatric interventions in some patients. How far these can help in avoiding invasive bariatric procedures in near future remains to be explored. An updated and comprehensive clinical review by He et al in the recent issue of World Journal of Diabetes address has addressed the avenues and challenges of currently available bariatric surgeries which will enable clinicians to make better decisions in their practice, including their applicability in special populations like the elderly and pediatric age groups, type 1 diabetes mellitus, and non-diabetics.
Core Tip: Bariatric intervention by invasive or endoscopic procedures can result in substantial weight loss and metabolic benefits like glycemic control in patients with obesity. However, their availability, immediate and long-term complications, cost, and weight regain are challenges. In their updated and comprehensive clinical review in the recent issue of World Journal of Diabetes, He et al has discussed the nitty-gritty of the currently available bariatric surgeries, including post-operative monitoring and applicability in special populations like the elderly, adolescents, type 1 diabetes mellitus, and non-diabetics.
