Dr Manjunath Maruti from AIIMS suggests that metabolic surgery may offer a long-term solution for selected patients with stubborn type-2 diabetes, highlighting recent evidence of enhanced remission rates and prompting calls for multidisciplinary evaluation.
Metabolic surgery may offer a route to remission for some people with type-2 diabetes whose blood sugar remains uncontrolled despite medicine and lifestyle changes, according to Dr Manjunath Maruti of the All India Institute of Medical Sciences in New Delhi. He said the operation should be seen not as a universal answer, but as one option for carefully chosen patients whose diabetes continues to worsen despite standard treatment.
Maruti said the procedure is generally considered when HbA1c, the long-term blood sugar marker, stays above 7.5% even after treatment with several oral medicines, with or without newer drugs such as GLP-1 receptor agonists or insulin. It may also be offered when insulin has already been started because tablets are no longer enough, or when early signs of diabetes-related organ damage appear, including kidney involvement, poor circulation, heart disease, stroke or eye damage.
The case for surgery rests on more than short-term glucose control. A 2023 systematic review and meta-analysis indexed on PubMed found that bariatric surgery outperformed usual care in achieving diabetes remission, while a National Institutes of Health-supported study has also reported better long-term blood sugar control and higher rates of remission among people who had surgery than among those managed with medication and lifestyle measures alone.
Recent reviews have suggested that remission can be substantial in selected patients, although the results vary by procedure and by the patient’s age, duration of diabetes and need for insulin before surgery. An expert opinion paper published on PubMed says remission is generally defined by normalised HbA1c and fasting glucose that remain stable for at least six months, underscoring that the outcome is measured over time rather than immediately after surgery.
Maruti argued that the decision should balance the upfront expense and risks of surgery against the long-term burden of uncontrolled diabetes, which can lead to dialysis, heart procedures, amputations and stroke. He said prevention remains the first line of defence, but people whose diabetes stays uncontrolled despite appropriate treatment should be reviewed by a multidisciplinary team at a centre with experience in both diabetes care and metabolic surgery.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
