The Great Debate: Medicine or Surgery

What Is Best for the Patient With Type 2 Diabetes?

David Lautz, MD; Florencia Halperin, MD; Ann Goebel-Fabbri, PHD; Allison B. Goldfine, MD


Diabetes Care. 2011;34(3):763-770. 

In This Article


Emerging data suggest that bariatric surgery results in substantial improvements in glycemia, blood pressure, and cholesterol; weight loss is durable; survival may be improved; and surgical risks are low. Novel surgical approaches are under development. At the same time, there have been substantial medical advances, and multiple pharmacologic agents are now available to treat diabetes and manage cardiovascular risk; pharmacologic weight loss agents and multipronged lifestyle strategies with multidisciplinary care are showing promise. Understanding the relative risks and benefits of different treatment approaches for individuals with type 2 diabetes, as well as the health care and other costs of such treatments, on a societal level will be of utmost importance in the coming years. Lessons from the study of the neurohormonal changes after bariatric surgery may inform not only the best surgical procedure but also lead to development of novel medical therapies, gastrointestinal interventions, or combination approaches to offer optimal management for the prevention or treatment of type 2 diabetes.


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