Metabolic Mechanisms of Type 2 Diabetes and Obesity: Challenges and Lessons from Bariatric/Metabolic Surgery

Dear Colleagues,

Severe obesity represents a major risk factor for the development of type 2 diabetes mellitus (T2DM). Most adults with T2DM are overweight or obese, suggesting an important role of increased adiposity as a risk factor for diabetes. Due to a shared common ground between obesity and T2DM, the term of “diabesity” is often used to highlight the causal pathophysiological link between the two phenomena. Numerous clinical trials have advocated bariatric/metabolic surgery over nonsurgical interventions because of markedly superior metabolic outcomes in morbidly overweight and obese patients. Nevertheless, it appears that not all obese patients with T2DM can achieve the most beneficial outcome (e.g., diabetes remission) beyond weight loss and food restriction. Thus, it is highly recommended that patients should be carefully selected based on rigorous preoperative assessment of the risk–benefit ratio prior to surgery. Predictors for diabetes remission following bariatric/metabolic intervention include indices such as preserved pancreatic beta-cell function, shorter duration of diabetes, younger age, higher C-peptide level, potential for an insulin resistance reduction, higher baseline BMI, and visceral fat area. Remarkably, trials have shown a marked variability in outcomes among patients subjected to metabolic surgery, suggesting that other mechanisms may be involved in the development of metabolic deterioration of T2DM in obese patients. At present, the exact metabolic mechanisms in T2DM and obesity are not well defined, and it is not clear yet which metabolic deterioration occurs first, insulin resistance or hyperinsulinemia. Although it has been determined that changes in the gastrointestinal tract, gut microbiome, adipokines levels, and bile acid could be involved in the remission of T2DM, treating T2DM patients by metabolic surgery remains highly controversial in the endocrinology community. More focused research in these areas might be directed to better understand the pathogenesis of obesity and T2DM in order to implement a tailored therapy for patient care and management.

This Special Issue aims to provide an open access platform to publish original research articles dedicated on existing knowledge and challenges in the management of T2DM and obesity. We would also like to invite researchers to submit review articles aimed at providing a comprehensive overview of the recent advances in understanding the molecular basis of T2DM in obesity and its treatment and/or prevention. Researchers from various scientific communities are welcome to present their latest research with a focus on metabolic mechanisms, leading to a better understanding of pathophysiology of T2DM and obesity.

Dr. Ahmed Bakillah
Dr. Ali Al Qarni
Guest Editors

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• Bariatric surgery
• Metabolic surgery
• Type 2 diabetes
• Diabetes mellitus
• Insulin resistance
• Hyperinsulinemia
• Metabolic syndrome
• Obesity
• Diabetes remission
• Weight loss
• Food restriction