Is Type 2 Diabetes a Surgical Disease?

  • Kai Tai Derek Yeung
  • Ahmed R. AhmedEmail author


Type 2 diabetes mellitus (T2DM) affects and will continue to affect more and more people across the globe. It is a complex disease process leading to significant morbidity, mortality and burden on healthcare systems.

Bariatric/metabolic surgery is effective at improving outcomes in obese patients and in those with obesity-related diseases. In particular, with type 2 diabetes mellitus (T2DM), glycaemic control is achieved rapidly before weight loss and is sustained. Recently the emergence of level 1 evidence supporting the superiority of surgery over intense medical therapy for diabetes has changed and continues to change many minds that doubted the benefit of surgery in diabetic patients.

We are only beginning to understand the metabolic effects of surgery. Many still think this is due to dietary restriction and weight loss leading to improvement in diabetes; there is, however, much more to it than this. In this chapter we will examine what is known about surgery for T2DM.


Bariatric Metabolic Diabetes Remission Gastric bypass Sleeve gastrectomy Gastric band 


  1. 1.
    De Block C, Van Gaal L. Bariatric surgery to treat type 2 diabetes. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):352–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Scheen A, Van Gaal L. Weight management in type 2 diabetes: current and emerging approaches to treatment. Diabetes Care., [online]. 2015;38(6):1161–72.CrossRefPubMedGoogle Scholar
  3. 3.
    Petry T, Caravatto P, Cohen R. Metabolic surgery for type 2 diabetes in patients with a BMI of <35 kg/m2: a surgeon’s perspective. Obes Surg. 2013;23(6):809–18.CrossRefPubMedGoogle Scholar
  4. 4.
    Magovern G, Sancetta A, Friedman M. The amelioration of diabetes mellitus following subtotal gastrectomy. Surg Gynecol Obstet., [online]. 1955;100(2):201–4.PubMedGoogle Scholar
  5. 5.
    Swanson M, Meelheim H, Flickinger E, Card J, Pories W. The control of diabetes mellitus (NIDDM) in the morbidly obese with the greenville gastric bypass. Ann Surg. 1987;206(3):316–23.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Card J, OʼBrien K, Brown B, Long S, Leggett-Frazier N, Morgan E, Swanson M, Khazanie P, May H, Barakat H, Sinha M, Dohm G, Flickinger E, Macdonald K, Pories W. Is type II diabetes mellitus (NIDDM) a surgical disease? Ann Surg. 1992;215(6):633–43.CrossRefGoogle Scholar
  7. 7.
    Dohm L, Dolezal J, Israel G, deRamon R, Barakat H, Brown B, Morris P, Long S, MacDonald K, Swanson M, Pories W. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–52.CrossRefGoogle Scholar
  8. 8.
    Brethauer S, Schauer P, Kirwan J, Corcelles R, Augustin T, Jamal M, Aminian A. Failed surgical weight loss does not necessarily mean failed metabolic effects. Diabetes Technol Ther. 2015;17(10):682–4.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Abbasi J. Unveiling the “magic” of diabetes remission after weight-loss surgery. JAMA. 2017;317(6):571–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Schauer P, Chand B, Kroh M, Rogula T, Kirwan J, Kashyap S, Kennedy L, Mackey J, Batayyah E, Romero-Talamás H, Aminian A, Brethauer S. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258:1.CrossRefGoogle Scholar
  11. 11.
    Sjöström L. Review of the key results from the Swedish obese subjects (SOS) trial – a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.CrossRefPubMedGoogle Scholar
  12. 12.
    Sledge I, Bantle J, Pories W, Jensen M, Banel D, Fahrbach K, Estok R, Buchwald H. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–256.e5.CrossRefPubMedGoogle Scholar
  13. 13.
    Rubino F, Ghirlanda G, Castagneto M, Pomp A, Nanni G, Leccesi L, Iaconelli A, Guidone C, De Gaetano A, Panunzi S, Mingrone G. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.CrossRefPubMedGoogle Scholar
  14. 14.
    McGlennon T, Buchwald J, Ribaric G. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2013;24(3):437–55.PubMedCentralGoogle Scholar
  15. 15.
    Nawroth P, Büchler M, Fischer L, Diener M, Helfert S, Vit G, Billeter A, Kenngott H, Warschkow R, Senft J, Müller-Stich B. Surgical versus medical treatment of type 2 diabetes mellitus in nonseverely obese patients. Ann Surg. 2015;261(3):421–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Cohen R, Cummings D. Bariatric/metabolic surgery to treat type 2 diabetes in patients with a BMI <35 kg/m2. Diabetes Care. 2016;39(6):924–33.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Qiu M, Jiang D, Zhang W, Shan C, Rao W. A meta-analysis of short-term outcomes of patients with type 2 diabetes mellitus and BMI ≤35 kg/m2 undergoing roux-en-Y gastric bypass. World J Surg. 2014;39(1):223–30.Google Scholar
  18. 18.
    Hu R, Qu S, Liu C, Zhao W, Zhang Z, Gong W, Feng X, Zhang S, He M, Huang Y, Ye Z, Yang Z, Chen L, Li Q. Metabolic effects of bariatric surgery in type 2 diabetic patients with body mass index < 35 kg/m2. Diabetes Obes Metab. 2011;14(3):262–70.PubMedGoogle Scholar
  19. 19.
    Folli F, Tian H, Liu G, Dhakal N, Li S, Baskota A. Bariatric surgery for type 2 diabetes mellitus in patients with BMI <30 kg/m2: a systematic review and meta-analysis. PLoS One. 2015;10(7):e0132335.CrossRefGoogle Scholar
  20. 20.
    NICE. Obesity: Identification, assessment and management. 2014. [online] Available at: Accessed 15 Jan 2017.
  21. 21.
    Thivolet C, Gouillat C, Laville M, Simon C, Espalieu P, Disse E, Ferrand-Gaillard C, Robert M. Predictive factors of type 2 diabetes remission 1 year after bariatric surgery: impact of surgical techniques. Obes Surg. 2013;23(6):770–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Sjöström L, Peltonen M, Jacobson P. Association of bariatric surgery with long term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304.CrossRefPubMedGoogle Scholar
  23. 23.
    Chen J, Lee Y, Chong K, Wu C, Ser K, Chen S, Lee W, Aung L. Bariatric surgery for patients with early-onset vs late-onset type 2 diabetes. JAMA Surg. 2016;151:798–805.CrossRefPubMedGoogle Scholar
  24. 24.
    Yang T, Xu J, Wu Y, Ma N, Han G, Zhang J, Hui Y, Yin D, Xu N, Yan Y, Wang G. Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis. Obes Surg. 2014;25(2):199–208.PubMedCentralGoogle Scholar
  25. 25.
    Mingrone G, Carnicelli A, De Gaetano A, Panunzi S. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery. Ann Surg. 2015;261(3):459–67.CrossRefPubMedGoogle Scholar
  26. 26.
    Ferraz A, Zeve J, Araujo-Junior J, Silva L, Lins D, Campos J. Metabolic surgery, weight regain and diabetes re-emergence. Arq Bras Cir Dig. 2013;26:57–62.CrossRefPubMedGoogle Scholar
  27. 27.
    Wichelmann C, Germer C, Seyfried F, Bender G, Hartmann D, Thalheimer A, Jurowich C. Improvement of type 2 diabetes mellitus (T2DM) after bariatric surgery—who fails in the early postoperative course? Obes Surg. 2012;22(10):1521–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Anderson M, Bailey M, Proietto J, Skinner S, Schachter L, Chapman L, Playfair J, O'Brien P, Dixon J. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.PubMedGoogle Scholar
  29. 29.
    Esteban Varela J, Nguyen N. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers. Surg Obes Relat Dis. 2015;11(5):987–90.CrossRefPubMedGoogle Scholar
  30. 30.
    Gagner M, Hutchinson C, Rosenthal R. Fifth international consensus conference: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(4):750–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Altuntas Y, Ozturk F, Oba S, Sayin P, Isil C, Bostanci O, Kaya C, Demir U, Bozkurt E, Isil R, Mihmanli M. Postoperative effects of laparoscopic sleeve gastrectomy in morbid obese patients with type 2 diabetes. Springerplus. 2016;5:497.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Musella M, Susa A, Greco F, De Luca M, Manno E, Di Stefano C, Milone M, Bonfanti R, Segato G, Antonino A, Piazza L. The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc. 2013a;28(1):156–63.CrossRefPubMedGoogle Scholar
  33. 33.
    Lee W, Chong K, Lin Y, Wei J, Chen S. Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect. Obes Surg. 2014;24(9):1552–62.CrossRefPubMedGoogle Scholar
  34. 34.
    Min Z, Yu B, Zhang P, Zhuang B, Xu M, Ye M, Huang A, Quan Y. Efficacy of laparoscopic mini gastric bypass for obesity and type 2 diabetes mellitus: a systematic review and meta-analysis. Gastroenterol Res Pract., [online]. 2015;2015:152852.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Murphy R, Plank L, Yip S. Gastric bypass and sleeve gastrectomy for type 2 diabetes: a systematic review and meta-analysis of outcomes. Obes Surg., [online]. 2013;23(12):1994–2003. Available at: [Accessed 26 Aug 2016].
  36. 36.
    Forse R, Osmolak A, Torgersen Z. Sleeve gastrectomy and roux en Y gastric bypass: current state of metabolic surgery. Curr Opin Endocrinol Diabetes Obes. 2014;21(5):352–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Rosenthal R, Szomstein S, Park S, Menzo L, Kim H, Cho J. Effect of sleeve gastrectomy on type 2 diabetes as an alternative treatment modality to roux-en-Y gastric bypass: systemic review and meta-analysis. Surg Obes Relat Dis : Off J Am Soc Bariatric Surg[online]. 2015;11(6):1273–80.CrossRefGoogle Scholar
  38. 38.
    Kashyap S, Kirwan J, Schauer P, Brethauer S, Nissen S, Bhatt D, Pothier C, Abood B, Wolski K, Samat A, Malin S. Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes: effects of bariatric surgery vs standard medical therapy. Int J Obes. 2013;38(3):364–70.Google Scholar
  39. 39.
    Flum D, Foster-Schubert K, Kratz M, Landers J, Bock S, Chan C, Stewart S, Kuzma J, Westbrook E, Arterburn D, Cummings D. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016;59(5):945–53.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Kashyap S, Nissen S, Kim E, Pothier C, Aminian A, Navaneethan S, Brethauer S, Wolski K, Kirwan J, Bhatt D, Schauer P. Bariatric surgery versus intensive medical therapy for diabetes – 3-year outcomes. N Engl J Med. 2014;370(21):2002–13.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Schauer P, Bhatt D, Kirwan J, Wolski K, Aminian A, Brethauer S, Navaneethan S, Singh R, Pothier C, Nissen S, Kashyap S. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Rubino F, Bornstein S, Castagneto M, Nanni G, Iaconelli A, Guidone C, De Gaetano A, Panunzi S, Mingrone G. Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73.CrossRefPubMedGoogle Scholar
  43. 43.
    Korner J, Wang Q, Laqua P, Bainbridge H, Olofson A, Schone J, Belani K, Ahmed L, Vella A, Jensen M, Sarr M, Chuang L, Chong K, Jeffery R, Inabnet W, Leslie D, Connett J, Thomas A, Bantle J, Lee W, Billington C, Ikramuddin S. Roux-en-Y gastric bypass for diabetes (the diabetes surgery study): 2-year outcomes of a 5-year, randomised, controlled trial. Lancet Diabetes Endocrinol. 2015;3(6):413–22.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Courcoulas A, Belle S, Neiberg R, Pierson S, Eagleton J, Kalarchian M, DeLany J, Lang W, Jakicic J. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment. JAMA Surg. 2015;150(10):931.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Carlsson L, Sjöholm K, Svensson P, Wedel H, Taube M, Sjöström E, Näslund I, Lönroth H, Karason K, Carlsson B, Bouchard C, Anveden Å, Andersson-Assarsson J, Ahlin S, Jacobson P, Peltonen M, Sjöström L. Association of Bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297.CrossRefPubMedGoogle Scholar
  46. 46.
    Frampton G, Loveman E, Pickett K, Colquitt J. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014. [online] Available at: Accessed 26 Aug 2016.
  47. 47.
    Cummings D, Taroncher-Oldenburg G, Kaplan L, Amiel S, Herman W, Sadikot S, Ji L, Del Prato S, Zimmet P, Alberti K, Schauer P, Eckel R, Nathan D, Rubino F. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861–77.CrossRefPubMedGoogle Scholar
  48. 48.
    Musella M, Savastano S, Lupoli R, Gaudioso D, Taffuri C, Bianco P, Maietta P, Leongito M, Minno D, Milone M. Bariatric surgery and diabetes remission: sleeve gastrectomy or mini-gastric bypass? World J Gastroenterol., [online]. 2013b;19(39):6590–7.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Ikramuddin S, Korner J, Lee W, Connett J, Inabnet W, Billington C, Thomas A, Leslie D, Chong K, Jeffery R, Ahmed L, Vella A, Chuang L, Bessler M, Sarr M, Swain J, Laqua P, Jensen M, Bantle J. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia. JAMA. 2013;309(21):2240.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Jakicic J, Lang W, DeLany J, Kalarchian M, Eagleton J, Pierson S, Neiberg R, Belle S, Courcoulas A. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment. JAMA Surg. 2015;150(10):931.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Ikramuddin S, Korner J, Lee W, Bantle J, Thomas A, Connett J, Leslie D, Inabnet W, Wang Q, Jeffery R, Chong K, Chuang L, Jensen M, Vella A, Ahmed L, Belani K, Olofson A, Bainbridge H, Billington C. Durability of addition of roux-en-Y gastric bypass to lifestyle intervention and medical management in achieving primary treatment goals for uncontrolled type 2 diabetes in mild to moderate obesity: a randomized control trial. Diabetes Care. 2016;39(9):1510–8.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Wolfe B, Courcoulas A, Flum, Cummings D, McCloskey C, Staten M, Garcia L, Mitchell J, Dakin G, Pomp A, Pories W, Pender J, Wahed A, Selzer F, Purnell J. Type 2 diabetes remission rates after laparoscopic gastric bypass and gastric banding: results of the longitudinal assessment of Bariatric surgery study. Diabetes Care., [online]. 2016;39(7):1101–7.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Bariatric SurgerySt Mary’s HospitalLondonUK
  2. 2.Department of Bariatric SurgerySt Mary’s Hospital, Imperial College LondonLondonUK

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