Surgical Treatment of Type 2 Diabetes

Gastrointestinal operations, originally used to treat severe obesity (“bariatric” or “weight-loss surgery”) cause rapid reversal of type 2 diabetes (disease remission) in many patients.

For a long-time this effect has been considered a consequence of weight loss; however, experimental studies in the early 2000s, pioneered by Francesco Rubino and colleagues demonstrated that gastrointestinal surgery has direct effects on diabetes, independent of weight loss.

This finding provided a biological rationale to repurpose gastrointestinal operations and bariatric surgery as an intentional treatment of type 2 diabetes itself, a practice now referred to as “metabolic surgery”.

On the back of this evidence, over 50 scientific organizations from around the world, including the American Diabetes Association, now recognize metabolic surgery as a standard-of-care option for T2D, including in patients with only mild obesity.

Lessons learned from the study of metabolic surgery have also led to novel endoscopic-endoluminal approaches that target the gut from the inside (via oral endoscopy) to treat diabetes and/or obesity.

Further research to elucidate the exact mechanisms by which surgery improves T2D could also help uncover the elusive cause of the disease and identify targets for entirely new types of therapeutics (including novel drugs and targeted nutritional approaches).

The evidence that metabolic surgery can directly induce durable remission of diabetes has, for the first time, advanced the idea that diabetes is not inevitably progressive and irreversible and that a cure for this grievous disease is obtainable.

Despite such compelling clinical evidence and broad professional consensus, the uptake of metabolic surgery for the treatment of Type 2 diabetes remains extremely low: in most countries, less than 1% of surgical candidates have access to a potentially life-saving treatment option.