The Impact of Bariatric Surgery on Incident Microvascular Complications in Patients With Type 2 Diabetes: A Matched Controlled Population-Based Retrospective Cohort Study

High BMI, silicone oil tamponade, and recurrent vitreous hemorrhage predict poor visual outcomes after pars plana vitrectomy in proliferative diabetic retinopathy

BACKGROUND

Proliferative diabetic retinopathy (PDR) is a serious microvascular complication of diabetes and a leading cause of global vision loss. Pars plana vitrectomy (PPV) is the primary surgical treatment for PDR, but visual outcomes vary due to multiple influencing factors. This study aims to evaluate the factors predicting visual prognosis in patients with PDR after PPV.

METHODS

A retrospective analysis was performed on 112 eyes from 87 patients with PDR who underwent PPV between May 2020 and May 2024. Data collected included patient demographics, preoperative and postoperative best-corrected visual acuity (BCVA), and other baseline clinical data. Data analysis was performed with IBM SPSS Statistics Version 24.0. Univariate and multivariate linear regression models were applied to assess the relationship between the final BCVA and various clinical parameters.

RESULTS

The mean BCVA improved significantly, from 1.94 ± 0.89 logMAR preoperative to 0.76 ± 0.70 logMAR postoperatively (P < 0.001). Multivariate linear regression identified body mass index (BMI) (B = 0.035; 95% CI 0.003-0.066; P = 0.033), silicone oil (SO) tamponade (B = 0.354; 95% CI 0.005-0.643; P = 0.029), and recurrent vitreous hemorrhage (VH) (B = 0.585; 95% CI 0.304-0.867; P < 0.001) as significant negative predictors of final BCVA.

CONCLUSIONS

While PPV improves visual outcomes in PDR patients, factors such as high BMI, SO tamponade, and recurrent VH negatively affect prognosis and could serve as predictors of poor visual outcomes following the procedure. This study emphasizes the importance of tailored management strategy for PDR, including early intervention, optimal BMI control, and minimizing SO tamponade duration.

Short-Term and Long-Term Effects of Bariatric Surgery on Diabetic Retinopathy: A Systematic Review

Background and Objectives: Diabetic retinopathy (DR) is a common diabetes complication and a leading cause of blindness. Although bariatric surgery (BS) is well studied for diabetes management, its effects on DR onset and progression, particularly long-term outcomes, remain underexplored. This review seeks to evaluate the short- and long-term retinal outcomes of BS in diabetic patients. Materials and Methods: A systematic search of PubMed, Web of Science, and Cochrane Library was conducted following PRISMA 2020 guidelines, including the use of the PRISMA checklist and flow diagram. The search included English-language articles (2014-2024) using keywords like "diabetic retinopathy" and "bariatric surgery". The review excluded studies published in languages other than English, as well as reviews, case reports, and those lacking adequate data or relevance. The risk of bias was determined by using the Downs and Black checklist. A systematic review of the literature was conducted, and the results were organized and displayed in tables to summarize and compare the main findings. Results: After screening 158 articles, 13 studies involving 17,903 patients were selected, focusing on the effects of BS on DR progression and regression. Short-term data suggest that BS may stabilize or improve DR but poses risks of worsening in advanced cases, requiring careful monitoring. However, long-term findings are inconsistent, with evidence of both DR regression and progression. These variations highlight the need for further research. Discussion: BS generally improves DR progression, but its effect depends on preoperative severity and glycemic control. Further studies should explore additional risk factors to better predict DR outcomes post-surgery. Conclusions: BS improves weight management, blood pressure, and diabetes control, potentially benefiting DR. However, the long-term effects remain uncertain due to conflicting findings. Rapid glycemic changes after surgery may pose risks of DR progression. Large-scale, longitudinal studies are needed to clarify the role of BS in DR progression and regression.

Diabetic Neuropathy: A Guide to Pain Management

PURPOSE OF REVIEW

Diabetic neuropathy is a common complication of diabetes mellitus (DM) and can affect up to 50% of DM patients during their lifetime. Patients typically present with numbness, tingling, pain, and loss of sensation in the extremities. Since there is no treatment targeting the underlying mechanism of neuropathy, strategies focus on preventative care and pain management.

RECENT FINDINGS

Up to 69% of patients with diabetic neuropathy receive pharmacological treatment for neuropathic pain. The United States Food and Drug Administration (FDA) confirmed four drugs for painful diabetic neuropathy (PDN): pregabalin, duloxetine, tapentadol, and the 8% capsaicin patch. Nonpharmacological treatments such as spinal cord stimulation (SCS) and transcutaneous electrical nerve stimulation (TENS) both show promise in reducing pain in DM patients. Despite the high burden associated with PDN, effective management remains challenging. This update covers the background and management of diabetic neuropathy, including its epidemiology, pathogenesis, preventative care, and current therapeutic strategies.

The effect of bariatric surgery on diabetes related foot complications among patients with type 2 diabetes: A systematic review

BACKGROUND

Bariatric surgery leads to considerable weight loss and improved glycaemic control and seems to have a favourable impact on diabetes related foot complications (DFC).

OBJECTIVES

To assess the effect of bariatric surgery on diabetes related foot complications in patients with type 2 diabetes and determine whether DFC symptoms are improved after bariatric surgery.

METHODS

We searched MEDLINE, Embase and Cochrane Central Register of Controlled Trials. The primary outcome was the presence of DFC after bariatric surgery. The secondary outcome was the improvement of DFC after bariatric surgery among patients who already had DFC before surgery.

RESULTS

There were nine studies showing the presence of DFC post bariatric surgery and six detailing the changes in DFC post bariatric surgery. Bariatric surgery was not associated with a lower risk of developing or worsening DFC compared to conventional medical treatment based on 4 randomised control trials (IR 0.87, 95 % CI, 0.26, 2.98), while from observational studies was associated with 51 % lower risk of DFC (IR 0.49, 95 % CI, 0.31, 0.77). Bariatric surgery was associated with improvement in diabetic neuropathy assessment parameters including toe tuning fork score, self-reported neuropathy symptoms, neuropathy symptom score, and neuropathy symptom profile.

CONCLUSION

Bariatric surgery led to a greater reduction in developing or worsening DFC among patients with type 2 diabetes compared to medical treatment in observational studies, but not among RCTs. Bariatric surgery was associated with improvements in diabetic neuropathy related assessment parameters and symptoms. Bariatric surgery could be a promising treatment for patients with type 2 diabetes who are at high risk of DFC.

Analysis Using Various Models on the Effect of Metabolic Surgery on Cardiovascular Disease Risk in the Chinese Population with Obesity

Background

Some research have indicated that Bariatric and metabolic surgery (BMS) can reduce the risk of cardiovascular disease (CVD) among individuals with obesity. However, there are few reports available that focuses on assessing effect of BMS on the risk of CVD in Chinese population using multiple models.

Objective

This research aims to assess the function of BMS on the risk of CVD in Chinese patients with obesity using multiple CVD risk models.

Methods

We performed a retrospective analysis of the basic data and glycolipid metabolism data preoperatively and postoperatively from patients with obesity at our hospital. Subgroup analysis was carried out according to different surgical procedures. Then, the function of BMS on the risk of CVD in the Chinese population was assessed using four models, including: China-PAR risk model, Framingham risk score (FRS), World Health Organization (WHO) risk model, and Globorisk model.

Results

We enrolled 64 patients, 24 (37.5%) of whom underwent laparoscopic sleeve gastrectomy (LSG) while 40 (62.5%) underwent Roux-en-Y gastric bypass (RYGB). The 10-year CVD risk for patients calculated using the China-PAR risk model decreased from 6.3% preoperatively to 2.0% at 1 year postoperatively and was statistically significantly different. Similarly, the 10-year CVD risk of patients calculated using the FRS, WHO, Global risk model decreased significantly at 1 year postoperatively compared to preoperatively. When the FRS risk model was used to calculate the patients' 30-year postoperative CVD risk, there was a significant decrease at 1 year after surgery compared to the preoperative period. When employing various models to evaluate the 10-year CVD risk for LSG and RYGB, no statistically significant difference was found in the 1-year postoperative RRR between the procedures.

Conclusion

The CVD risk after BMS was significantly reduced compared to preoperatively. In terms of improving cardiovascular risk, SG and RYGB appear to be equally effective.

Gut microbiota induced abnormal amino acids and their correlation with diabetic retinopathy

AIM

To explore the correlation of gut microbiota and the metabolites with the progression of diabetic retinopathy (DR) and provide a novel strategy to elucidate the pathological mechanism of DR.

METHODS

The fecal samples from 32 type 2 diabetes patients with proliferative retinopathy (PDR), 23 with non-proliferative retinopathy (NPDR), 27 without retinopathy (DM), and 29 from the sex-, age- and BMI- matched healthy controls (29 HC) were analyzed by 16S rDNA gene sequencing. Sixty fecal samples from PDR, DM, and HC groups were assayed by untargeted metabolomics. Fecal metabolites were measured using liquid chromatography-mass spectrometry (LC-MS) analysis. Associations between gut microbiota and fecal metabolites were analyzed.

RESULTS

A cluster of 2 microbiome and 12 metabolites accompanied with the severity of DR, and the close correlation of the disease progression with PDR-related microbiome and metabolites were found. To be specific, the structure of gut microbiota differed in four groups. Diversity and richness of gut microbiota were significantly lower in PDR and NPDR groups, than those in DM and HC groups. A cluster of microbiome enriched in PDR group, including Pseudomonas, Ruminococcaceae-UCG-002, Ruminococcaceae-UCG-005, Christensenellaceae-R-7, was observed. Functional analysis showed that the glucose and nicotinate degradations were significantly higher in PDR group than those in HC group. Arginine, serine, ornithine, and arachidonic acid were significantly enriched in PDR group, while proline was enriched in HC group. Functional analysis illustrated that arginine biosynthesis, lysine degradation, histidine catabolism, central carbon catabolism in cancer, D-arginine and D-ornithine catabolism were elevated in PDR group. Correlation analysis revealed that Ruminococcaceae-UCG-002 and Christensenellaceae-R-7 were positively associated with L-arginine, ornithine levels in fecal samples.

CONCLUSION

This study elaborates the different microbiota structure in the gut from four groups. The relative abundance of Ruminococcaceae-UCG-002 and Parabacteroides are associated with the severity of DR. Amino acid and fatty acid catabolism is especially disordered in PDR group. This may help provide a novel diagnostic parameter for DR, especially PDR.

Molecular mechanism and intervention measures of microvascular complications in diabetes

Objective

In this article, the epidemiology, molecular mechanism of occurrence and development, risk factors, and treatment of diabetic microvascular complications such as diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy were discussed, providing the theoretical basis for more accurate elucidation of the pathogenesis and treatment of diabetic microvascular complications.

Methods

The electronic database of PubMed was searched, and retrieved papers were screened for eligibility by two independent reviewers. Data were extracted using a standardized data extraction form and the quality of included papers was assessed.

Results

Thirty-eight articles were included. Diabetes nephropathy, diabetes peripheral neuropathy, and diabetes retinopathy are the most common and serious microvascular complications of diabetes in clinical patients. Renin-angiotensin system blockers, beta drugs, statins, antivascular endothelial growth factor drugs, and antioxidants can inhibit the occurrence of microvascular complications in diabetes.

Conclusions

However, there has been no breakthrough in the treatment of diabetic microvascular complications. Therefore, prevention of diabetic microvascular complications is more important than treatment.

Evaluation of Healthcare Utilisation and Expenditures in Persons with Type 2 Diabetes Undergoing Bariatric-Metabolic Surgery

PURPOSE

Changes in healthcare utilisation and expenditures after bariatric-metabolic surgery (BMS) for people with type 2 diabetes mellitus (T2DM) are unclear. We used the Dutch national all-payer claims database (APCD) to evaluate utilisation and expenditures in people with T2DM who underwent BMS.

METHODS

In this cohort study, patients with T2DM who had BMS in 2016 were identified in the APCD. This group was matched 1:2 to a control group with T2DM who did not undergo BMS based on age, gender and healthcare expenditures. Data on healthcare expenditures and utilisation were collected for 2013-2019.

RESULTS

In total, 1751 patients were included in the surgery group and 3502 in the control group. After BMS, total median expenditures in the surgery group stabilised (€ 3156 to € 3120) and increased in the control group (€ 3174 to € 3434). Total pharmaceutical expenditures decreased 28% in the surgery group (€957 to €494) and increased 55% in the control group (€605 to €936). In the surgery group, 67.1% did not use medication for T2DM in 2019 compared to 13.3% in the control group. Healthcare use for microvascular complications increased in the control group, but not in the surgery group.

CONCLUSION

BMS in people with T2DM stabilises healthcare expenditures and decreases medication use and care use for microvascular complications. In contrast, healthcare use and expenditures in T2DM patients who do not undergo surgery gradually increase over time. Due to the progressive nature of T2DM, it is expected that these differences will become larger in the long-term.

Pharmacological and Nonpharmacological Treatments for Painful Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes. The lifetime prevalence of DPN is thought to be >50%, and 15%-25% of patients with diabetes experience neuropathic pain, referred to as "painful DPN." Appropriate treatment of painful DPN is important because this pain contributes to a poor quality of life by causing sleep disturbance, anxiety, and depression. The basic principle for the management of painful DPN is to control hyperglycemia and other modifiable risk factors, but these may be insufficient for preventing or improving DPN. Because there is no promising diseasemodifying medication for DPN, the pain itself needs to be managed when treating painful DPN. Drugs for neuropathic pain, such as gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, alpha-lipoic acid, sodium channel blockers, and topical capsaicin, are used for the management of painful DPN. The U.S. Food and Drug Administration (FDA) has approved pregabalin, duloxetine, tapentadol, and the 8% capsaicin patch as drugs for the treatment of painful DPN. Recently, spinal cord stimulation using electrical stimulation is approved by the FDA for the treatment for painful DPN. This review describes the currently available pharmacological and nonpharmacological treatments for painful DPN.

Glycemic outcomes in patients with type 2 diabetes after bariatric surgery compared with routine care: a population-based, real-world cohort study in the United Kingdom

BACKGROUND

Clinical trials have shown that bariatric surgery (BS) is associated with better glycemic control and diabetes remission in patients with type 2 diabetes (T2D) compared with routine care.

OBJECTIVE

We conducted a real-world population-based study examining the impact of BS on glycemic control and medications in patients with T2D.

SETTING AND METHODS

This was a retrospective, matched, controlled cohort study conducted between January 1, 1990, and January 31, 2018, using IQVIA Medical Research Data, a primary care electronic records database. Adults with body mass index (BMI) ≥30 kg/m² and T2D who had BS (surgical) were matched for age, sex, BMI, and diabetes duration to two controls (with T2D and no BS).

RESULTS

A total of 1126 patients in the surgical group and 2219 patients in the control group were analyzed. Mean (standard deviation) age was 50.0 (9.3) years, 67.6% were women, baseline glycocylated hemoglobin (HbA1C) was 7.8% (1.7 mmol/mol), and diabetes duration was 4.7 years (range, 2.0-8.4 years). Over a median (interquartile range) follow-up of 3.6 years (1.7-5.9 years), a higher proportion of patients in the surgical group achieved an HbA1C of ≤6.0% than the control group (65.8% versus 22.8%). The surgical group showed a decrease in mean HbA1C of 1.5% (95% confidence interval [CI]: 1.4%-1.7%), 1.4% (1.2%-1.5%), and 1.3% (1.1%-1.5%) at 1-, 2-, and 3-year follow-up, respectively, whereas HbA1C increased in the control group. The proportion of patients receiving glucose-lowering medications decreased in the surgical group (92.2% to 66.5%) but increased in the control group (85.3% to 90.2%).

CONCLUSION

BS is associated with significant improvement in glycemic control, achievement of normal HbA1C levels, and reduced need for glucose-lowering therapy in patients with T2D.

The role and mechanisms of gut microbiota in diabetic nephropathy, diabetic retinopathy and cardiovascular diseases

Type 2 diabetes mellitus (T2DM) and T2DM-related complications [such as retinopathy, nephropathy, and cardiovascular diseases (CVDs)] are the most prevalent metabolic diseases. Intriguingly, overwhelming findings have shown a strong association of the gut microbiome with the etiology of these diseases, including the role of aberrant gut bacterial metabolites, increased intestinal permeability, and pathogenic immune function affecting host metabolism. Thus, deciphering the specific microbiota, metabolites, and the related mechanisms to T2DM-related complications by combined analyses of metagenomics and metabolomics data can lead to an innovative strategy for the treatment of these diseases. Accordingly, this review highlights the advanced knowledge about the characteristics of the gut microbiota in T2DM-related complications and how it can be associated with the pathogenesis of these diseases. Also, recent studies providing a new perspective on microbiota-targeted therapies are included.

Machine Learning Models for Inpatient Glucose Prediction

PURPOSE OF REVIEW

Glucose management in the hospital is difficult due to non-static factors such as antihyperglycemic and steroid doses, renal function, infection, surgical status, and diet. Given these complex and dynamic factors, machine learning approaches can be leveraged for prediction of glucose trends in the hospital to mitigate and prevent suboptimal hypoglycemic and hyperglycemic outcomes. Our aim was to review the clinical evidence for the role of machine learning-based models in predicting hospitalized patients' glucose trajectory.

RECENT FINDINGS

The published literature on machine learning algorithms has varied in terms of population studied, outcomes of interest, and validation methods. There have been tools developed that utilize data from both continuous glucose monitors and large electronic health records (EHRs). With increasing sample sizes, inclusion of a greater number of predictor variables, and use of more advanced machine learning algorithms, there has been a trend in recent years towards increasing predictive accuracy for glycemic outcomes in the hospital setting. While current models predicting glucose trajectory offer promising results, they have not been tested prospectively in the clinical setting. Accurate machine learning algorithms have been developed and validated for prediction of hypoglycemia and hyperglycemia in the hospital. Further work is needed in implementation/integration of machine learning models into EHR systems, with prospective studies to evaluate effectiveness and safety of such clinical decision support on glycemic and other clinical outcomes.

Benefits of weight loss of 10% or more in patients with overweight or obesity: A review

OBJECTIVE

Modest weight loss (5%-10%) is clinically meaningful in patients with overweight or obesity. However, greater weight loss may be required to achieve improvements in or remission of certain weight-related complications. Therefore, this study reviewed the effect of large weight loss (≥10%). Most studies reporting large weight loss and relevant outcomes used bariatric surgery or lifestyle modifications.

RESULTS

Benefits of large weight loss were observed in patients with various overweight- or obesity-related complications, including improvements in comorbidities such as type 2 diabetes and hypertension. Improvements in glucose metabolism and cardiovascular risk factors were observed in patients who achieved large weight loss through lifestyle interventions or pharmacotherapy (phentermine/topiramate 15/92 mg once daily or subcutaneous semaglutide 2.4 mg once weekly). Other benefits associated with large weight loss included reduced cancer risk and improvements in knee osteoarthritis, sleep apnea, fertility-related end points, and health-related quality of life. While costly, bariatric surgery is currently the most cost-effective intervention, although most weight-management programs are deemed cost-effective.

CONCLUSIONS

Overall, large weight loss has a major beneficial impact on overweight- and obesity-related complications. Large weight loss should be the main treatment target when modest weight loss has had insufficient effects on obesity-related complications and for patients with severe obesity.

The clustering of Cardiovascular, Renal, Adipo-Metabolic Eye and Liver disease with type 2 diabetes

Type 2 diabetes is associated with an increased risk of cardiovascular disease, heart failure, chronic kidney disease, fatty liver disease, eye and foot disease. But equally, these conditions are associated with an increased risk of type 2 diabetes. Rather than being simply considered complications of diabetes, as exists within a 'pure' type 1 diabetes paradigm, both type 2 diabetes and its comorbidities are primarily caused by a failure to efficiently sequester excess energy leading to the accumulation of sick fat (adiposopathy). Type 2 diabetes is a symptom of a chronic disease complex, just as cardiovascular, renal, eye, foot and/or liver disease, are. In addition, each of these conditions feed forward so that dysfunction in one system accelerates dysfunction in another, partly through their shared pathogenesis and partly due dysfunction that follows in their wake. This review will explore the sticky, brittle conglomeration of CArdiac, Renal, Adipo-Metabolic, Eye and Liver disease (hereafter collectively known as CARAMEL disease) that is coincident in most patients with type 2 diabetes and contextualise the recent changes in diabetes guidelines that now specifically focus on identifying and aggressively managing these high-risk individuals with it.

Diabetic Foot Risk Classification at the Time of Type 2 Diabetes Diagnosis and Subsequent Risk of Mortality: A Population-Based Cohort Study

AIM

We aimed to compare the mortality of individuals at low, moderate, and high risk of diabetic foot disease (DFD) in the context of newly diagnosed type 2 diabetes, before developing active diabetic foot problem.

METHODS

This was a population-based cohort study of adults with newly diagnosed type 2 diabetes utilizing IQVIA Medical Research Data. The outcome was all-cause mortality among individuals with low, moderate, and high risk of DFD, and also in those with no record of foot assessment and those who declined foot examination.

RESULTS

Of 225,787 individuals with newly diagnosed type 2 diabetes, 34,061 (15.1%) died during the study period from January 1, 2000 to December 31, 2019. Moderate risk and high risk of DFD were associated with increased mortality risk compared to low risk of DFD (adjusted hazard ratio [aHR] 1.50, 95% CI 1.42, 1.58; aHR 2.01, 95% CI 1.84, 2.20, respectively). Individuals who declined foot examination or who had no record also had increased mortality risk of 75% and 25% vs. those at low risk of DFD, respectively (aHR 1.75, 95% CI 1.51, 2.04; aHR 1.25, 95% CI 1.20, 1.30).

CONCLUSION

Individuals with new-onset type 2 diabetes who had moderate to high risk of DFD were more likely to die compared to those at low risk of DFD. The associations between declined foot examination and absence of foot examinations, and increased risk of mortality further highlight the importance of assessing foot risk as it identifies not only patients at risk of diabetic foot ulceration but also mortality.

Pharmacotherapy to delay the progression of diabetic kidney disease in people with type 2 diabetes: past, present and future

Diabetic kidney disease (DKD) is a leading cause of morbidity and mortality among people living with diabetes, and is one of the most important causes of end stage renal disease worldwide. In order to reduce progression of DKD, important management goals include treatment of hypertension, glycaemia and control of cardiovascular risk factors such as lipids, diet, smoking and exercise. Use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers has an established role in prevention of progression of DKD. A number of other agents such as endothelin-1 receptor antagonists and bardoxolone have had disappointing results. Recent studies have, however, suggested that newer antidiabetic agents such as sodium-glucose transporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 analogues have specific beneficial effects in patients with DKD. Indeed most recent guidance suggest that SGLT-2i drugs should be used early in DKD, irrespective of glucose control. A number of pathways are hypothesised for the development and progression of DKD, and have opened up a number of newer potential therapeutic targets. This article aims to discuss management of DKD with respect to seminal trials from the past, more recent trials informing the present and potential new therapeutic options that may be available in the future.

Prognostic Models for Predicting Remission of Diabetes Following Bariatric Surgery: A Systematic Review and Meta-analysis

BACKGROUND

Remission of type 2 diabetes following bariatric surgery is well established, but identifying patients who will go into remission is challenging.

PURPOSE

To perform a systematic review of currently available diabetes remission prediction models, compare their performance, and evaluate their applicability in clinical settings.

DATA SOURCES

A comprehensive systematic literature search of MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) was undertaken. The search was restricted to studies published in the last 15 years and in the English language.

STUDY SELECTION

All studies developing or validating a prediction model for diabetes remission in adults after bariatric surgery were included.

DATA EXTRACTION

The search identified 4,165 references, of which 38 were included for data extraction. We identified 16 model development and 22 validation studies.

DATA SYNTHESIS

Of the 16 model development studies, 11 developed scoring systems and 5 proposed logistic regression models. In model development studies, 10 models showed excellent discrimination with area under the receiver operating characteristic curve ≥0.800. Two of these prediction models, ABCD and DiaRem, were widely externally validated in different populations, in a variety of bariatric procedures, and for both short- and long-term diabetes remission. Newer prediction models showed excellent discrimination in test studies, but external validation was limited.

LIMITATIONS

While the key messages were consistent, a large proportion of the studies were conducted in small cohorts of patients with short duration of follow-up.

CONCLUSIONS

Among the prediction models identified, the ABCD and DiaRem models were the most widely validated and showed acceptable to excellent discrimination. More studies validating newer models and focusing on long-term diabetes remission are needed.

Metabolic surgery: A clinical update

Metabolic and bariatric surgery has grown beyond 'experimental' weight-loss surgery. As techniques have advanced over the last few decades, so has the growing body of research and evidence, proving that both weight-loss and metabolic health improvement are induced. Metabolic surgery has become the more appropriate term for weight-loss surgery because of the altered gastrointestinal anatomy and subsequent beneficial metabolic effects. Although the tool of metabolic surgery has been well refined, a large portion of the global population does not have adequate access to it. This clinical update aims to (a) inform healthcare providers from all disciplines about the myriad of benefits of metabolic surgery and (b) equip them with the necessary knowledge to bridge the gap between patients in need of metabolic treatment and the therapies in metabolic surgery available to them.