Metabolic Surgery for Diabetes

Metabolic Surgery should be offered to all obese people with diabetes. The evidence for this recommendation is now irrefutable.

In 2016, the American Diabetes Association, the International Diabetes Federation, and 43 other medical groups published guidelines, in the journal Diabetes Care, recommending surgery as treatment for people suffering from obesity and Type 2 diabetes. The guidelines state that people with Type 2 diabetes and a body-mass index (BMI) equal to or over 40.0, or a BMI from 35.0-to-39.9 and poorly controlled Type 2 diabetes, should be advised to undergo surgery, and people with poorly controlled diabetes and a BMI of 30.0-to-34.9 should “consider” surgery.

The STAMPEDE Trial followed three groups of patients, about 150 people, with poorly controlled diabetes and obesity. One group underwent gastric bypass; one got sleeve gastrectomy; and one group was placed on an intensive medical weight loss program, including counseling and medications. After five years, half of the patients who had surgery had a HbA1c level less than 7.0%, while less than a quarter of those in the medical therapy group had similar success. One in five patients that underwent surgery had complete remission of their diabetes (HbA1c of 6.0% or less, without medications) while there were no cases of diabetes remission in the medical therapy group. Surgical patients also lost a lot more weight and required fewer heart medications after 5 years. The surgical patients even scored higher on quality-of-life measures.

Only skilled surgeons with low complication rates should perform these technically demanding procedures. Risks include infections leaks and blood clots early after surgery, and ulcers, reflux, gallstones, and malnutrition months to years after surgery. People that have undergone gastric bypass surgery need to take supplemental vitamins and minerals for the rest of their life.