Metabolic Surgery for Type 2 Diabetes

Who may be a candidate?

ASMBS/IFSO 2022 and ADA-supported statements consider metabolic surgery for adults with type 2 diabetes and BMI ≥ 30, particularly when glycaemic targets are not met with optimal medical therapy. Candidacy is decided individually after endocrinology and multidisciplinary review.

Procedure options

• Roux-en-Y gastric bypass — strong and durable effect on glycaemic control
• One-anastomosis (mini) gastric bypass — similar metabolic effect, single anastomosis
• Sleeve gastrectomy — restrictive, also improves metabolic parameters

How it works

Beyond reducing caloric intake, bypass-type procedures alter gut hormone signalling (GLP-1, PYY), bile acid metabolism and insulin sensitivity, which can lead to clinically meaningful improvement of type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnea. Individual results vary.

Long-term follow-up

Diabetes medications are reviewed in the early postoperative period in coordination with endocrinology. Lifelong vitamin/mineral supplementation and metabolic monitoring are required.