Bariatric surgery is more effective than intensive medical or lifestyle interventions for inducing weight loss and remission of type 2 diabetes as demonstrated in randomized clinical trials for patients with obesity—even for those with relatively lower body mass index (BMI), ranging from 30.0 to 34.9 (calculated as weight in kilograms divided by height in meters squared).1 Bariatric procedures may be associated with better survival and fewer cardiovascular events compared with nonsurgical management of patients with diabetes as shown in long-term observational studies; but even the best observational studies may not be definitive because of concerns about unmeasured confounding variables and selection bias. Thus, longer-term randomized clinical trials are also needed to provide definitive evidence of the durability and superiority of bariatric procedures compared with the best available medical and lifestyle treatment of type 2 diabetes.
David Arterburn, David McCulloch. Bariatric Surgery for Type 2 DiabetesGetting Closer to the Long-term Goal. JAMA. 2016;315(12):1276–1277. doi:10.1001/jama.2016.1884