[Metabolic surgery--the most effective diabetes treatment]

Bariatric operations resulting in a favourable metabolic effect--not only due to a reduction of excessive body weight--are known as metabolic surgery. Interventions into the digestive tract, especially the prevented contact of food with the duodenal and proximal jejunal lining and/or the effect of an insufficiently digested food on the jejunum, favourably affect incretin mechanisms. Thus, "resolution" of type 2 diabetes and discontinuation of antidiabetic medication can be achieved in as many as 95 percent of patients. Today, combined procedures (gastric bypass, biliopancreatic diversion) are indicated for diabetic subjects with severe obesity. The usefulness and indication of metabolic surgery for type 2 diabetics with less pronounced overweight have to be verified in prospective controlled studies.