A 20-year follow-up study of more than 600 type 2 diabetic patients in Sweden showed that patients with type 2 diabetes who underwent bariatric surgery had reduced rates of macrovascular and microvascular complications compared with matched controls. Principal investigator Lars, MD, PhD, professor of medicine at the University of Gothenburg, Sweden, reported at the 49th Annual Meeting of the European Association for the Study of Diabetes (EASD 2013) that although remission rates after bariatric surgery in patients with type 2 diabetes declined over time during the 20-year follow-up period, dropping to a minimum at 20 years, patients’ diabetic complications were prevented. The Swedish Study of Obese Subjects (SOS), previously reported by Dr. and colleagues, showed that a subgroup of patients who were diabetic at study entry had 72% of their type 2 diabetes in remission 2 years after bariatric surgery and 36% remained in remission 10 years after surgery (N. Engl. J. Med. 2004;351:2683-93). At this meeting, he reported data from longer follow-up, with the remission rate dropping further to 30% after 15 years and only 18% in remission after 20 years. after 20 years, about 3/4 of patients whose initial diabetes was in remission had a recurrence of diabetes. Despite this, the incidence of macrovascular and microvascular complications continued to decline in the bariatric surgery group compared to control patients. approximately 8% of patients requiring hospitalization for eye, kidney, peripheral nerve, and peripheral circulation after 10 years for the surgery group and 12% for the control group; this rate was 20% for the surgery group and 45% for the control group after 20 years, and the relative risk for the surgery group compared to the control group was found to be The relative risk was found to be 54% lower in the surgical group compared to the control group after 10 years of follow-up. Similar findings have been reported previously by his research group on the incidence of myocardial infarction. D. suggests, “Physicians should perform weight loss surgery for diabetic patients because of the reduced risk of diabetic complications observed in our long-term study. Even when diabetes recurs, patients have a reduced rate of complications because their risk factors for cardiovascular disease are still improving. The impact of surgery on diabetic complications remains strong even when diabetes relapses after 20 years. Weight loss surgery is a viable approach to better control diabetes.” In addition, in his report, Dr. noted that in addition to relieving diabetes and preventing complications, surgery also reduces the incidence of new-onset diabetes. A previous report from the SOS study showed that at 15 years of follow-up, the surgical group prevented new-onset diabetes (N. Engl. J. Med. 2012;367:695-704), that this effect was “still quite strong” after 20 years, and that the risk of incident diabetes in the surgical group during the 20-year follow-up period, compared with the control group The relative risk was reduced by 77% during the 20-year follow-up period. D., also called for lowering the BMI criteria for bariatric surgery, as patients with relatively low BMIs can achieve similar benefits after surgery. He and his team analyzed 233 patients in the SOS study who did not meet current bariatric surgery criteria due to low body mass index (BMI). This group had a mean BMI of 36 kg/m2 compared to 104 kg/m2 for those who underwent bariatric surgery (Diabetes Care 2013;36:1335-40). The results of their exploratory analysis showed similar benefits of bariatric surgery in patients with lower BMI and in patients with higher BMI who met standard surgical criteria. D., concluded that current bariatric surgery BMI criteria are not valid. Baseline BMI is not predictive of treatment outcomes in our study so far, and we should place more emphasis on metabolic variables to select patients who will benefit most from bariatric surgery.