Redefining Surgical Indications in Type 2 Diabetes: A Metabolic-Stage–Driven Approach in Non-Obese Populations
DOI:
https://doi.org/10.64784/083Keywords:
Metabolic surgery, type 2 diabetes mellitus, non-obese patients, endocrine modulation, patient selection, insulin sensitivity, chronic disease managementAbstract
Type 2 diabetes mellitus (T2DM) in non-obese individuals represents a growing clinical challenge, particularly in regions where metabolic risk is not adequately captured by body mass index alone. In recent years, metabolic surgery has gained attention as a potential therapeutic option for selected non-obese patients, based on evidence suggesting that its benefits extend beyond weight reduction and involve sustained endocrine modulation. This narrative review analyzes the evolving role of metabolic surgery in non-obese patients with T2DM, focusing on emerging selection criteria and reported endocrine outcomes. The review synthesizes international literature and conceptual frameworks of chronic disease management to identify consistent patterns in patient selection, underlying physiological mechanisms, and clinically relevant outcomes. Across the reviewed evidence, selection criteria increasingly prioritize beta-cell reserve, disease duration, metabolic phenotype, and glycemic refractoriness over anthropometric thresholds. Reported outcomes predominantly emphasize sustained glycemic control, reduction in pharmacologic treatment burden, and improvements in insulin sensitivity, while remission is described as a variable outcome dependent on baseline metabolic capacity and follow-up duration. The findings support the interpretation of metabolic surgery as a durable endocrine-modifying intervention that requires careful patient selection and structured long-term follow-up. This perspective is particularly relevant for Latin American healthcare systems, including those in Mexico, Colombia, and Ecuador, where chronic disease management is influenced by system-level factors such as continuity of care and access to multidisciplinary monitoring.
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