Patient Selection for Metabolic Surgery

The world diabetes pandemic, closely linked to the obesity pandemic, is increasingly demanding attention from the scientific community to improve treatment results and ameliorate metabolic complications, cardiometabolic risk factors and overall morbidity and mortality in diabetic patients. Medical treatment and lifestyle changes are the traditional approach for type 2 diabetes mellitus (T2DM), although poor results in modification of main endpoints for glycaemic control are achieved with this approach in most patients on the long term because of the progressive nature of the disease. In the past decades, reports on excellent control of metabolic parameters despite weight loss have risen great interest in bariatric surgery as a treatment for T2DM. Whereas weight loss no doubt plays a main role on the improvement of metabolic parameters in obese individuals submitted to weight loss procedures, the findings of significant control in metabolic parameters on early postoperative periods, despite insignificant weight loss, and the understanding of the physiopathology of enteroendocrine changes leading to excellent glycaemic control following bariatric procedures have stimulated research on the surgical treatment of T2DM, especially in mild obesity patients. Questions remain as to which diabetic patients can benefit of bariatric surgery to improve metabolic parameters, and whether patient selection for metabolic surgery can rely on the same diagnostic tools used to select nondiabetic patients for weight loss surgery. Thorough preoperative evaluation and adequate patient selection is key to success in surgery, and this section will focus on the adequate selection of patients for metabolic surgery in the range of obesity.