Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.

of the Clinical Problems Type 2 diabetes affects 12% to 14% of persons in the United States, with prevalence rates exceeding 20% in non-Hispanic black, Asian, and Hispanic populations.1 Pharmaceutical and behavioral approaches to restore glucose homeostasis and to avoid longterm complications of diabetes may be effective, but sustaining adherence is often difficult.2 Gastrointestinal operations (Roux-en-Y gastric bypass, vertical sleeve gastrectomy, laparoscopic adjustable gastric banding, and biliopancreatic diversion) provide substantial weight loss and often improve function and reduce obesity-related complications.3 Some consider bariatric interventions as metabolic surgeries when the goal is to improve metabolic health rather than weight alone, and these procedures can lead to changes in the gut microbiome and hormones, bile acid metabolism, and other factors that affect glucose homeostasis independent of weight loss.4 Recent studies and an emerging consensus suggest metabolic surgery to treat T2D in some patients. However, a firm link between controlling diabetes through metabolic surgery and preventing diabetes complications has yet to be established.