Metabolic Surgery for Type 2 Diabetes: Changing the Landscape of Diabetes Care

The accelerating pandemic of diabetes is recognized as one of the greatest global public health threats of our time (1). When one reviews the latest estimates for diabetes prevalence and projections worldwide, it is easy to appreciate the magnitude of the problem facing us not only today but also for generations to come. Given the microvascular and macrovascular complications associated with this disease, as well as the resulting morbidity and mortality, the personal, medical, and societal costs are enormous (2,3). In addition, despite continuing advances in diabetes pharmacotherapy, fewer than half of adults with type 2 diabetes mellitus (T2D) attain therapeutic goals designed to reduce long-term risks of complications, especially for glycemic control (4–6), and lifestyle interventions are disappointing in the long term (7). In facing these challenges, it is imperative that interventions that may interdict the disease process and complement existing therapies be expeditiously advanced into clinical practice while also balancing the costs attributed to each intervention.This month’s issue of Diabetes Care includes 11 articles that report the latest data supporting bariatric/metabolic surgery as a new treatment option in the management of T2D. In the centerpiece of this collection, Rubino et al. (8) report new evidence-based guidelines for surgical treatment of T2D, writing on behalf of 48 voting delegates (75% are nonsurgeons) of the 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference organized in collaboration with major diabetes organizations. These recommendations, endorsed thus far by 45 international professional societies [see Table 1, Rubino et al. (8)], reflect a large body of evidence demonstrating that several gastrointestinal (GI) operations initially designed to promote weight loss (bariatric surgery) can improve glucose homeostasis more effectively than any known pharmaceutical or behavioral approach (9–24), causing durable remission in many patients with T2D (25,26 …