Bariatric Procedure Selection in Diabetics

Bariatric surgery is an effective treatment for obesity and improving obesity related comorbidities, including Type 2 diabetes (T2DM). Several procedural options exist, and thoughtful selection based on patient factors and preferences is important to maximize desired outcomes, while minimizing risk of harm. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed procedures and have moderate, but important differences in metabolic outcomes. RYGB is superior for diabetes remission in patients with moderate diabetes compared to SG. The distinction is less clear when considering patients with mild or severe diabetes. More data are needed to assess the risk to benefit ratio of more aggressive operations such as duodenal switch (DS). Diabetes recidivism occurs in 30–50% of patients; however, long-term metabolic benefits persist. We review the current data supporting bariatric procedure selection in diabetic patients and discuss available tools to guide patient-centered procedure selection.