The head of the General Surgery and Digestive Apparatus Service of the University Hospital of the Southeast and surgeon at the Ruber Juan Bravo Hospital, Dr. Alfredo Alonso Poza, highlights that surgery aimed at treating obesity in patients with type 2 diabetes provides benefits that go beyond weight loss. As he explains, this type of intervention can optimize glucose control, reduce the need for medications, and promote disease remission, with effects that can be maintained for long periods.
"The result of surgery is measured not only by the kilos lost, but also by how it improves diabetes control and whether the need for medication is reduced," the expert explains.
The so-called metabolic surgery can be considered in people with type 2 diabetes and obesity who meet criteria to undergo intervention. The recommendations of the American Diabetes Association of 2026 include this alternative starting from a body mass index of 30, always after a personalized evaluation and with the involvement of a specialized multidisciplinary team.
The likelihood of achieving remission is also not the same in all patients. A shorter duration of diabetes, a lower degree of disease progression, and not requiring insulin are associated with higher remission percentages. These elements help to adjust expectations, although they do not allow guaranteeing the outcome in each specific case.
"The assessment must be individual. Not all people with obesity and diabetes have the same course or the same possibilities of achieving remission. That is why it is important to study each case and explain what results can be expected," says Dr. Alonso Poza.
The ARMMS-T2D study, published in JAMA in 2024 and funded by the National Institutes of Health of the United States, analyzed 262 people from four clinical trials that compared bariatric surgery with conventional medical treatment and interventions on lifestyle habits. Follow-up lasted up to 12 years, and made it possible to observe benefits even in participants with a body mass index between 27 and 34.
At seven years, remission was detected in 18.2% of those assigned to surgery, compared with 6.2% of the group treated only with medication and lifestyle changes. At twelve years, the rates were 12.7% and 0%, respectively. In addition, the group subjected to surgical intervention showed better glucose control and required fewer diabetes drugs. These data indicate that the beneficial metabolic effect can be maintained over time, although not all patients achieve remission.
Nevertheless, it is recalled that remission does not equal definitive cure.
The international consensus on type 2 diabetes usually defines remission as a glycated hemoglobin (HbA1c, a marker of the average glucose level) below 6.5%, sustained for at least three months without the usual glucose-lowering medications. An improvement in laboratory parameters while continuing drug treatment may reflect good control, but it does not meet the remission criterion.
"Achieving remission is an important outcome, but it does not mean that diabetes is cured forever. Even if the patient stops needing medication, they must continue with follow-ups, because glucose can rise again," the doctor warns.
Remission also does not exempt from controlling possible complications associated with the disease. For this reason, the consensus recommends verifying at least once a year that remission is maintained and continuing with the usual diabetes monitoring.