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Invited Commentary
September 2016

Is Early Bariatric Surgery the Answer for Diabetes in Obesity?

Author Affiliations
  • 1Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Surg. 2016;151(9):806. doi:10.1001/jamasurg.2016.1148

The article by Aung et al1 in this issue of JAMA Surgery continues the excellent clinical research from the group in Taiwan. Multiple randomized studies have demonstrated the efficacy of bariatric surgery in treating type 2 diabetes (T2D), and the term metabolic surgery is being increasingly used, although it is not always well defined. In their introduction, Aung and colleagues define this surgery as “the application of bariatric surgical procedures to patients with a body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of less than 35 who also have severe comorbidities.”1 We feel defining it as the manipulation of the gastrointestinal tract with the goal of treating T2D is not only more appropriate but also more representative of what the authors have evaluated in their study. In this article, the authors compare the outcomes of bariatric surgery in those with early-onset T2D (age <40 years) and late-onset T2D (age ≥40 years) and conclude that early intervention leads to better rates of complete diabetes remission (hemoglobin A1c <6.0% [to convert to proportion of total hemoglobin, multiply by 0.01] without antidiabetic medication).1