A doctor at AIIMS emphasises that metabolic surgery may help some patients with stubborn type 2 diabetes achieve remission, but stresses it should be reserved for carefully selected cases with persistent high blood sugar despite medical treatment.
Metabolic surgery may help some people with stubborn type 2 diabetes achieve remission, according to Dr. Manjunath Maruti of the All India Institute of Medical Sciences in New Delhi, but he stressed that it is not a universal treatment and should be reserved for carefully selected patients whose blood sugar stays high despite medicines and lifestyle changes. The clinician said the procedure belongs among evidence-based options for people whose disease remains difficult to control, rather than being seen as a solution for everyone with diabetes.
The protocol used by his unit considers surgery when a patient’s HbA1c, a measure of average blood sugar, remains above 7.5% despite treatment with more than three oral diabetes medicines, with or without a GLP-1 receptor agonist or insulin. Maruti said patients should usually have had type 2 diabetes for at least two years, and surgery may also be considered when insulin has already been started because medication is no longer enough. Early organ damage linked to diabetes, including kidney involvement, reduced blood flow to the legs, heart disease, stroke or vision loss, can also strengthen the case for surgery even if the HbA1c threshold has not been reached.
Maruti said the decision should not be made on the basis of immediate expense alone, because uncontrolled diabetes can lead to far greater costs over time. He pointed to complications such as kidney failure, heart disease, eye damage, peripheral vascular disease and stroke as examples of the long-term burden that can follow years of poor control. The National Institutes of Health has also reported that bariatric surgery can deliver durable glucose control and higher remission rates in type 2 diabetes compared with medical treatment alone, adding weight to the view that surgery can be effective in selected patients.
The doctor said prevention should remain the priority, with attention to diet, exercise, sleep and early diagnosis, and that patients whose diabetes remains uncontrolled should be reviewed by a multidisciplinary team at a dedicated centre. He said his unit has treated 67 patients with uncontrolled type 2 diabetes, including people with body mass indexes between 23 and 35 and diabetes lasting 15 to 25 years, as part of its effort to assess the procedure’s role in more complex cases. Longer-term follow-up, he added, will be needed to determine how durable remission and metabolic gains remain after 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.
