Type 2 Diabetes

Metabolic Surgery “Underutilized” in Type 2 Diabetes, Despite Benefits

Published in partnership with American Society for Metabolic and Bariatric Surgery logo


A new meta-analysis has found that metabolic surgery is associated with reduced mortality and decreased incidence of microvascular complications in patients with type 2 diabetes.1


These findings, which were presented at the 35th American Society for Metabolic & Bariatric Surgery (ASMBS) Annual Meeting at ObesityWeek 2018, add to a growing body of evidence on the benefits of metabolic surgery for this patient population.

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“This analysis shows metabolic surgery is the only therapy that beneficially affects all diabetes-related complications, at the same time resulting in fewer deaths and cardiovascular events,” said lead study author Adrian T Billeter, MD, PhD, of the University of Heidelberg in Germany. 2


“The majority of diabetes medications do not have such an effect, so the case for metabolic surgery is very compelling,” he explained.2


For their study, Dr Billeter and colleagues performed a systematic literature search, which yielded 2815 articles. Nineteen articles were ultimately included in their analysis.


Evidence indicated that metabolic surgery was associated with decreased all-cause mortality compared with medical therapy, regardless of type 2 diabetes duration (odds ratio [OR] 0.34).


Metabolic surgery was also shown to significantly lower the incidence of all microvascular complications (OR 0.38) compared with medical therapy, although longer diabetes duration reduced this effect.


Despite these positive findings, however, surgery remains “vastly underutilized” in the treatment of obesity, type 2 diabetes, and its complications, said ASMBS president Samer Mattar, MD, medical director at Swedish Weight Loss Services in Seattle, Washington, who was not involved in the study.2


“While metabolic surgery is certainly not for everyone – there are many factors to consider – many are missing out on a transformational procedure,” Dr Mattar said.


—Christina Vogt



1. Billeter AT, Eichel S, Scheurlen K, Kopf S, Probst P, Müller-Stich BP. Metabolic surgery reduces mortality and microvascular complications in patients with type 2 diabetes mellitus compared with medical therapy: a meta-analysis. Paper presented at: American Society for Metabolic & Bariatric Surgery Annual Meeting at ObesityWeek 2018; November 11-15, 2018; Nashville, TN.


2. Metabolic surgery significantly better than drug therapy in reducing risk of death and complications in patients with diabetes [press release]. Nashville, TN. American Society for Metabolic & Bariatric Surgery. November 14, 2018. Accessed on November 14, 2018.