Diabetes Surgery

What is Metabolic Surgery?

Metabolic surgery refers to surgical interventions aimed at controlling metabolic diseases (such as Type 2 diabetes, hypertension, liver fatty infiltration, dyslipidemia, etc.) associated with obesity.

In fact, all obesity surgeries fall under the scope of metabolic surgery. This is because these surgeries not only promote weight loss but also contribute to the regression or complete resolution of metabolic diseases.

Because of these effects, obesity surgeries are now defined as therapeutic metabolic interventions.

What is Diabetes Surgery?

In medical literature, there is no official procedure known as “Diabetes Surgery” or “Sugar Surgery.” This term is commonly used in the public, especially referring to the significant improvements observed in Type 2 diabetes after obesity surgery.

Bariatric/metabolic surgery can change the course of diabetes in patients with Type 2 diabetes through:

Decreased HbA1c levels
Reduction or complete elimination of medication requirements
Preservation of pancreatic insulin reserves

These positive outcomes can alter the progression of diabetes.

STAMPEDE Study: Scientific Evidence

The STAMPEDE study, conducted by Cleveland Clinic, scientifically demonstrated the effectiveness of metabolic surgery.

In this study, patients with Type 2 diabetes and BMI >30 kg/m² were divided into two groups:

Those who received only medical treatment
Those who underwent bariatric surgery (Sleeve Gastrectomy or Gastric Bypass)

Results:

In patients who underwent surgery:

HbA1c control was much more effectively achieved
Diabetes remission (improvement) was observed at a higher rate
Long-term complication rates decreased

This study showed that metabolic surgery is superior to medical approaches in the treatment of Type 2 diabetes.

Can Low BMI Patients Undergo Metabolic Surgery?

New guidelines and scientific data suggest that metabolic surgery could be an effective option for patients with a BMI between 30–35 kg/m² who experience severe diabetes control problems.

However, metabolic surgery is not yet recommended for patients with BMI <30 kg/m² according to international standards. [caption id="attachment_6458" align="aligncenter" width="650"] * Obesity and Metabolic Surgery Clinical Protocol. Department of Research, Development and Health Technology Assessment. Ministry of Health of the Republic of Turkey. Ankara, 2021.[/caption]

Current Metabolic Surgery Criteria in Turkey

According to the Obesity and Metabolic Surgery Clinical Protocol published by the Ministry of Health of the Republic of Turkey in 2021, the criteria for metabolic surgery candidates are as follows:

BMI ≥ 35 kg/m²
Patients with a BMI between 30–35 kg/m² and severe diabetes complications (e.g., eye, kidney, nerve system damage)
Type 2 diabetes cases that cannot be controlled despite conservative treatments (diet, exercise, medication)

All patients should be evaluated from a medical, nutritional, and psychological perspective by a multidisciplinary team.

Metabolic surgery is not only a method for weight loss but also a scientifically proven powerful approach in controlling life-threatening metabolic diseases like diabetes.

If you have Type 2 diabetes and it cannot be controlled despite treatment, metabolic surgery may be an option for you.