Diabetes, just as obesity, is a disease classified as pandemic. This means a globalized epidemic, that is, a disease that is beyond the control of doctors and scientists. Brazil has the fourth highest number of people with diabetes in the world, and half of those affected by this disease are undiagnosed.

As a result, the impact on public health has increased. After all, the future of a diabetic patient can be of serious complications such as heart attack, blindness, renal failure, and even the possible need for amputation due to circulatory problems. Thus, there was an increase in the mortality and morbidity of these patients, in addition to an increase in the concurrent personal, medical and social cost. And, unfortunately, most of these patients are also obese, worsening their prognosis.

We know that the treatment of obesity and weight loss have a relationship of improvement of diabetes. This disease has already been treated for years with medication, changing eating habits, and physical activity. However, less than half of these patients achieved satisfactory results with the conservative treatment. We needed something more effective.

And so, the bariatric surgery appeared, showing a higher impact than expected. What impressed the scientific community was the speed of the glycemic control and thus diabetes, after the surgical procedure. The patient shows an improvement in blood glucose levels within hours after surgery, showing that the impact is independent of weight loss. In the post-operative period, due to the anatomical alteration, there is an improvement of the action of insulin and therefore the control of diabetes. The so-called metabolic surgery was born!

Metabolic surgery is defined as the gastrointestinal tract surgery intended to treat diabetes and obesity. It can be performed through bariatric surgical techniques already established by the Brazilian Society of Bariatric and Metabolic Surgery (Sociedade Brasileira de Cirurgia Bariátrica e Metabólica – SBCBM) and by the International Federation of Obesity Surgery (Federação Internacional de Cirurgia da Obesidade – IFSO). The types of surgical procedures are: Gastric Bypass, Gastric Sleeve, Gastric Banding and Duodenal Switch Surgery. Any other procedure besides these is treated as experimental surgery and still requires scientific evidence to be performed. The main technique choice for metabolic surgery in the world today is the Gastric Bypass, considering its mechanism of action, safety, low morbidity and mortality, and good long-term results. For the best results in bariatric surgery, the patient should seek Centers of Excellence with an experienced multidisciplinary team in the management of diabetes and obesity.

In the last 5 years, the scientific community has been flooded with several good studies corroborating the control of diabetes, reduction in associated medications and improvement in the quality of life of patients who underwent metabolic surgery, including those patients with BMI < 35 kg/m2. For us, experts in obesity and diabetes, it is increasingly evident that the indication of metabolic surgery depends more on the severity of diabetes than on the patient's obesity itself.

Metabolic Surgery is the only treatment, so far, capable of producing remission of type 2 diabetes. If you have any questions, schedule an appointment with us!

• 90% of the operated patients present remission of diabetes during 10 and 15 years of post-operative, against 5% of the non-operated patients who follow conservative disease control programs.
• 92% reduction in diabetes-related mortality has been observed in the operated group by several epidemiological studies in a 16 years follow-up.

• Risk of fistulas (0.09% and 0.1%), venous thrombosis of the legs and pulmonary embolism, intestinal obstruction or bleeding.
• It is a surgery contraindicated for autoimmune diabetics, and type 1 and type 2 diabetes patients with advanced disease in which the pancreas has no reserve of beta cells to produce insulin.