Bariatric surgery and type 2 diabetes mellitus. Are all surgical techniques the same?

Both obesity and type 2 diabetes mellitus (T2DM) are two major health problems out of control and with a significant health cost. The main risk factor for the development of T2DM is suffering from obesity, and nearly 90% of patients with T2DM are overweight or obese. Bariatric Surgery can lead to a long-term resolution T2DM in more than half of people with obesity and diabetes who undergo this surgery. Bariatric surgery highlights the current limitations of medical treatment of obesity, and brings up important issues, such as: should we offer surgical treatment to patients with diabetes and obesity when medical therapy fails?, where in the T2DM therapy algorithm, should bariatric surgery be placed?, what surgical technique would be more indicated, and at what body mass index should it be recommended? A better understanding of the pathophysiological mechanisms responsible for the resolution of T2DM after the bariatric surgery will help to properly answer the questions above raised above, and potentially contribute to the development of effective medical treatments, alternatives to bariatric surgery. (C) 2012 Sociedad Espanola de Diabetes. Published by Elsevier Espana, S. L. All rights reserved.