Once considered exclusively as a weight-loss procedure for severely obese patients, there is more than 20 years of evidence supporting metabolic surgery as an effective treatment for type 2 diabetes, resulting in improvement or remission in the majority of cases.
Obesity is medically defined as a body mass index (BMI) of 30 kg/m² or more. It is a significant independent risk factor for developing the disease. Approximately 90% of people with type 2 diabetes are obese or overweight (BMI of at least 25)(21).
Randomized clinical trials show that metabolic surgery, especially gastric bypass, achieves results of complete remission or improvement of diabetes within two years in more than 90% of patients, in some cases at the time of hospital discharge and even before significant weight loss occurs (22).
Studies show that metabolic surgery is superior to non-surgical treatment involving drugs. Intensive therapy and intervention style producing long-term diabetes remission with 25-50% more surgery patients maintaining glycemic control without medication (23) (24).
Global clinical guidelines approved by 45 medical professional societies include metabolic surgery as a treatment option for type 2 diabetes in patients with a BMI of 30 or more. (25).
Main Guidelines and Recommendations
2018: The American Society for Metabolic and Bariatric Surgery (ASMBS) position statement on the role of bariatric surgery in class I obesity (BMI 30.0 to 34.9 kg/m2) states “Particularly given the presence of high-quality data in patients with type 2 diabetes, bariatric and metabolic surgery should be strongly considered for patients with a BMI of 30 to 35 kg/m2 and type 2 diabetes.” The statement is supported by the American Diabetes Association (ADA) and has been endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). (26)
2018: ADA’s annually updated “Standards of Medical Care in Diabetes-2018” guidelines maintain an emphasis on metabolic surgery for the treatment of type 2 diabetes, including the 2017 expansion of the indication for metabolic surgery to include patients with inadequately controlled diabetes who are mildly obese, with a body mass index as low as 30.
