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

doi:10.4239/wjd.v15.i10.2036

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

World J Diabetes. 2024 Oct 15;15(10):2036-2040. doi: 10.4239/wjd.v15.i10.2036.

Authors

Ryan J Jalleh¹, Karen L Jones¹, Md Shahidul Islam², Lu Cai³, Michael Horowitz⁴

Affiliations

¹ 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.
² Department of Biochemistry, School of Life Sciences, University of KwaZulu-Natal, Durban 4000, KwaZulu-Natal, South Africa.
³ 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.
⁴ 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. [email protected]. [email protected].

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.

Publication types

Editorial