Metabolic surgery: a new step towards precision medicine

Raverdy V, Cohen RV, Caiazzo R, Verkindt H, Petry TBZ, Marciniak C, Legendre B, Bauvin P, Chatelain E, Duhamel A, Drumez E, Oukhouya-Daoud N, Chetboun M, Baud G, Ahlqvist E, Wierup N, Asplund O, Laferrère B, Groop L, Pattou F.

Lancet Diabetes Endocrinol. 2022 Mar;10(3):167-176. doi: 10.1016/S2213-8587(22)00005-5

Obesity surgery or bariatric surgery aims to sustainably reduce weight and control the deleterious effects associated with obesity. It consists of modifying the anatomy of the digestive system, which makes it possible to reduce the quantity of food consumed and/or the assimilation of food by the body. In patients who also have type 2 diabetes, bariatric surgery also causes a rapid decrease in blood sugar (glycaemia). The number of patients who could theoretically benefit from surgery could be considerable. In clinical practice, the indications for this effective but invasive approach are still debated for type 2 diabetes. Surgical outcome is also variable, consistent with overwhelming evidence supporting the heterogeneous and multifactorial nature of diabetes as a disease.

A new classification of type 2 diabetes has recently been proposed to identify people at increased risk of diabetes progression and to predict response to treatment. In this regard, Professor PATTOU’s team (UMR 1190, EGID, Univ Lille, CHU de Lille, Inserm, Institut Pasteur de Lille) tested this new classification in severely obese patients undergoing metabolic surgery. The team thus identified a subgroup of patients who are associated with the best outcomes after metabolic surgery, both in terms of improving diabetes and kidney function. These results, published in the prestigious journal Lancet Diabetes Endocrinol, may represent an additional step towards the implementation of precision medicine in metabolic surgery.