Prediabetes: Epidemiology, diagnosis, and management

Table 5 Summary of metabolic and bariatric surgical procedures relevant to obesity-associated prediabetes

Procedure	Mechanism/nature	Potentially suitable population	Procedure summary	Main limitations or complications
RYGB	Combined restrictive and malabsorptive procedure	Patients with obesity and marked metabolic abnormalities; evidence in prediabetes is mainly derived from obesity cohorts or indirect T2DM data[30,100,101]	Creation of a small gastric pouch with jejunal anastomosis, bypassing the distal stomach, duodenum and proximal jejunum[102]	Nutritional deficiencies, anastomotic leak, hemorrhage, dumping symptoms, and need forlong-term follow-up[102,104,126]
LAGB	Restrictive procedure	Patients requiring a less invasive, adjustable, and reversible procedure; now less commonly used because of weaker long-term weight-loss and metabolic effects[106,108]	Placement of an adjustable silicone band around the upper stomach to create a small gastric pouch[106]	Band slippage, port-related problems, erosion, insufficient weight loss, band removal, or conversion to other procedures[106,127]
SG/VSG	Mainly restrictive procedure with metabolic effects	Commonly performed procedure; may be suitable for patients with obesity and prediabetes, although direct prediabetes evidence remains limited[30,110,111]	Resection of most of the stomach along the greater curvature, leaving a tubular gastric sleeve[109]	GERD, staple-line leak, bleeding, and possible nutritional deficiencies[109,110,112]
BPD/DS	Combined restrictive and strongly malabsorptive procedure	Mainly considered for severe or super obesity, especially BMI ≥ 50 kg/m2, or as a revisional option after insufficient response to other procedures[113-115]	Sleeve gastrectomy with preservation of the pylorus and intestinal bypass[115]	Higher risk of nutritional deficiencies, protein-calorie malnutrition, fat-soluble vitamin deficiency, diarrhea, malodorous flatus, anastomotic leak, and hemorrhage[115,116]

The evidence for several procedures is derived mainly from obesity or type 2 diabetes mellitus cohorts and should not be directly generalized to all individuals with prediabetes. RYGB: Roux-en-Y gastric bypass; LAGB: Laparoscopic adjustable gastric banding; SG/VSG: Sleeve gastrectomy/vertical sleeve gastrectomy; BPD/DS: Biliopancreatic diversion with duodenal switch; GERD: Gastroesophageal reflux disease; T2DM: Type 2 diabetes mellitus.