METABOLIC SURGERY AS A TREATMENT FOR TYPE II DIABETES: LITERATURE REVIEW

• DOI: https://doi.org/10.22533/at.ed.1594442413056

• Palavras-chave: Bariatric; Metabolic surgery; Type 2 Diabetes Mellitus.

• Keywords: Bariatric; Metabolic surgery; Type 2 Diabetes Mellitus.

• Abstract:

  INTRODUCTION: Metabolic surgery, also known as bariatric surgery, is an essential tool in the treatment of obesity and Type 2 Diabetes Mellitus (DM2). In addition to promoting weight loss, this intervention positively influences metabolic health, especially through changes in the gastrointestinal tract. Although its effectiveness in T2D remission is proven, the exact mechanisms underlying these benefits are not yet completely understood. Given the growing number of cases of obesity and DM2, it is essential to further investigate this relationship to improve the clinical management of these complex conditions. OBJECTIVE: Analyze the effectiveness and mechanisms of action of metabolic surgery in the treatment of DM2. 
  METHODOLOGY: A literature review was carried out using the database MEDLINE-PubMed, covering studies published between 2014 and 2024. Of the 250 studies found, 20 were selected after critical analysis. The inclusion criteria were based on the descriptors "Metabolic Surgery" AND "Bariatric Surgery" AND "Obesity" AND "type 2 diabetes" excluding animal studies and narrative reviews. RESULTS: The benefits, such as rapid improvement in blood glucose and glycemic homeostasis, are observed immediately after the procedure, even without weight loss. Studies indicate high long-term DM2 remission rates, ranging between 59.3% and 91.2%, depending on the type of surgery. Metabolic surgery also reduces other comorbidities of obesity and improves quality of life. However, more research is needed to understand the long-term risks and benefits, as well as compare its effectiveness with conventional treatments for T2D. DISCUSSION: Metabolic surgery induces remission of DM2 through several mechanisms, such as mobilization of triglycerides in the liver and pancreas and hormonal changes that improve insulin sensitivity. Furthermore, changes in the intestinal microbiota and bile acid signaling contribute to the reduction of insulin resistance. Bariatric surgery also improves glycemic control and reduces HbA1c. These procedures are promising for patients with obesity and DM2 resistant to conventional treatment, improving both metabolic parameters and quality of life. CONCLUSION: Metabolic and bariatric surgery is effective in treating DM2, in addition to weight loss. Bariatric therapy induces remission by influencing hormonal and metabolic systems, while metabolic therapy is an alternative for refractory patients to conventional treatment with a higher BMI. A personalized approach is crucial, integrated into general care. Recent advances, such as new eligibility criteria, represent progress. In summary, both are effective options for remission of DM2 and reduction of complications.