From bariatric to metabolic surgery: Looking for a “disease modifier” surgery for type 2 diabetes

Core Tip

Core tip: In severely obese patients with type 2 diabetes mellitus (T2DM), weight loss after bariatric surgery is often accompanied by long term remission of T2DM and other obesity co-morbidities, these anti-diabetic outcomes are due both to body fat loss and to still unknown factors specifically regulated by surgery. On the other hand, the same surgical procedures in obese patients with a body mass index < 35, are associated with T2DM remission in only 50% of subjects. These findings raise the question whether bariatric surgery could be considered a metabolic one. We propose that “bariatric” surgery could be considered “metabolic” only in the case that it could demonstrate its effect on long lasting T2DM remission in morbid as well as in non-morbid obese subjects.