There is mounting evidence that
bariatric surgery leads to higher remission rates of
type 2 diabetes than any conventional medical treatment, lifestyle intervention, or medically supervised weight loss program. Although remission rates of
type 2 diabetes may be as high as 66.7 % after
gastric bypass and 28.6 % after gastric band, very few
bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results. Hence, trials that directly compare
bariatric surgery procedures with medical and lifestyle intervention for patients with
type 2 diabetes are the best candidate for assessing the role of
bariatric surgery in diabetes remission. Three randomized controlled trials and one prospective study have so far been published comparing the effect of
Roux-en-Y gastric bypass (RYGB) procedure against optimal medical
therapy, with a follow-up ranging from 1 to 6 years: the percentage of diabetic patients in remission (
hemoglobin A1C < 6-6.5 % without medications) ranged from 38 to 75 % at the end of follow-up. Intensive lifestyle intervention is also superior to conventional treatment for inducing remission of
type 2 diabetes, with remission rates of
type 2 diabetes between 10 and 15 % at 1 year of follow-up.
Bariatric surgical procedures, especially RYGB, are more effective at inducing initial
type 2 diabetes remission in obese patients, but more information is needed about the long-term durability of comorbidity control and complications after bariatric procedures. In the meantime, all efforts should be directed toward primary prevention of
type 2 diabetes, given the encouraging results of lifestyle intervention studies.