The indication for a metabolic surgery procedure is given if the aim is to improve blood sugar levels in diabetes mellitus type 2. Since weight reduction also begins at the same time, the patient benefits not only from an improvement in the diabetic metabolism but also from an improvement in the quality of life through weight reduction.
Metabolic surgery is indicated only for pre-existing type 2 diabetes mellitus and not for type 1, which is an autoimmune disease that does not respond to metabolic surgery!
Patients who are eligible for metabolic surgery should first undergo diabetes training and nutritional advice in preparation for the procedure. The indications for the intervention in pre-existing diabetes mellitus type 2 are:
- BMI ≥ 40 kg/m²
- BMI ≥ 35 kg/m² and < 40 kg/m² if conservative treatment fails to improve blood sugar levels
- BMI ≥ 30 kg/m² and < 35 kg/m² if conservative treatment fails to improve blood sugar levels -> intervention may be considered
- BMI < 30 kg/m² -> only in the context of scientific studies
Metabolic surgery procedures should only be performed in a centre with special experience. For the indication of a BMI < 40 kg/m², it is recommended to consult a diabetologist.
As before every surgery procedure, alternative treatment methods must also be discussed when discussing a metabolic surgery with the patient, i.e. the conservative possibilities of weight reduction and methods for diabetes control.
Bilbiography sources:
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Brethauer SA, Aminian A, Romero-Talamas H, et al. (2013) Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg 258: 628–636
Buchwald H, Avidor Y, Braunwald E, et al. (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122: 248–256
Carlsson LM, Peltonen M, Ahlin S, et al. (2012) Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med 367: 695–704
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Pories WJ, Swanson MS, MacDonald kg, et al. (1995) Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222: 339–350
Schauer PR, Bhatt DL, Kirwan JP, et al. (2014) Bariatric Surgery versus Intensive Medical Therapy for Diabetes – 3 Year Outcomes. N Engl J Med 370: 2002–2013
