RESUMO
INTRODUCTION: Metabolic surgery (MS) can be a useful therapeutic strategy in patients with type 2 diabetes (DM2) and obesity. OBJECTIVE: To define the place of MS within DM2 treatment in Mexico. METHODS: A committee of experts consisting of internists and surgeons representing the leading Mexican associations involved in the field was created. Each one responded to a specific question regarding mechanisms involved in controlling DM2, surgical procedures, and the indications and contraindications for MS. This document was prepared based on the presentation and discussion of such answers. RESULTS: Obesity through insulin resistance, incretins, bile salts, and intestinal microbiota plays a determining role in the appearance of DM2. MS improves glucose homeostasis by reducing weight and intake, increasing incretins, and modifying bile salts and microbiota. MS leads to remission of DM2 and reduces cardiovascular risk factors in well-selected cases. We recommend MS as a therapeutic option in DM2 and grade III obesity regardless of metabolic control and grade II and grade I obesity with poor glycemic control. MS could be considered an option in grade II obesity with good metabolic control in the presence of associated comorbidities. Gastric bypass presents the most favorable risk-benefit profile. CONCLUSIONS: Current evidence endorses the inclusion of MS in the algorithm for treatment of DM2 and obesity. The therapeutic approach must be multidisciplinary at experienced centers.