Management of type 2 diabetes after metabolic bariatric surgery

Metabolic and bariatric surgery has been proven to be effective in the glycemic and metabolic control of type 2 diabetes (T2D) and obesity. While most patients experience remission of T2D after surgery, some individuals remain with suboptimal glycemic control. In addition, a significant subset of patients experience relapse of diabetes in the long term after attaining diabetes remission. As a heterogenous disease, the underlying etiology of T2D and response to treatment can be variable in different individuals. The mechanism of diabetes relapse is not completely understood as is the optimal medical management of T2D after metabolic and bariatric surgery. Nonetheless, person-centred collaborative and supportive care beyond the monitoring of parameters forms the cornerstone in formulating care for people with diabetes. This paper reviews the clinical management of T2D after bariatric surgery, including persistent T2D or diabetes relapse after initial remission.