Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI 35 kg/m2

摘要

OBJECTIVEGlobal usage of bariatric surgery has been dictated for the past quarter century by National Institutes of Health recommendations restricting these operations to individuals with a BMI ≥35 kg/m². Strong evidence now demonstrates that bariatric procedures markedly improve or cause remission of type 2 diabetes mellitus (T2DM), in part through weight-independent mechanisms, and that baseline BMI does not predict surgical benefits on glycemic or cardiovascular outcomes. This impels consideration of such operations as “metabolic surgery,” which is used expressly to treat T2DM, including among patients with a BMI <35 kg/m² who constitute the majority of people with diabetes worldwide. Here, we review available evidence to inform that consideration.