Metabolic Surgery in Mérida

Dr. Montserrat Monroy · Board-Certified Bariatric Surgeon (CMCG)
Last medical review: July 2026

What Is Metabolic Surgery?

Metabolic surgery refers to bariatric surgical procedures performed with the primary goal of improving metabolic conditions — particularly type 2 diabetes — rather than weight loss alone. While the surgical techniques are often the same as those used in bariatric surgery, the focus shifts to treating the underlying metabolic disease.

Type 2 diabetes is a chronic condition in which the body does not adequately use insulin, causing elevated blood glucose levels. When diabetes occurs in patients with obesity, there is a direct relationship between excess weight and insulin resistance that makes disease control difficult.

Bariatric and metabolic surgery has been shown to be one of the most effective tools for improving type 2 diabetes control in patients with obesity. Multiple scientific studies have documented that, beyond weight loss, the hormonal and intestinal changes produced by surgery independently contribute to improving insulin sensitivity and glucose regulation.

It is important to clarify that surgery is not a universal "cure" for diabetes; results vary by patient. However, in many cases it can achieve partial or complete disease remission, allowing medication reduction or discontinuation under medical supervision.

How Does Surgery Help Diabetes?

The mechanisms by which surgery improves diabetes go beyond simple weight loss:

• Intestinal hormonal changes: surgery modifies the production of hormones such as GLP-1 and incretins, which improve insulin secretion and glucose regulation. These changes can be observed even before significant weight loss.
• Reduced insulin resistance: loss of visceral fat (deep abdominal fat) directly improves tissue sensitivity to insulin.
• Modified intestinal transit: in procedures like gastric bypass, the change in how food travels through the intestine activates metabolic mechanisms that promote glycemic control.
• Changes in gut microbiota: surgery produces modifications in intestinal flora that may contribute to improved glucose metabolism.

Who Is a Candidate for Metabolic Surgery?

International guidelines (ADA, IFSO, ASMBS) recommend considering metabolic surgery for type 2 diabetes patients in the following scenarios:

• BMI ≥35 kg/m² with type 2 diabetes: surgery is an established therapeutic option, regardless of glycemic control.
• BMI 30 to 34.9 kg/m² with poorly controlled diabetes: when diabetes is not adequately managed despite optimal medical treatment (multiple medications, insulin), metabolic surgery may be considered.
• Diabetes with comorbidities: patients who also present hypertension, dyslipidemia, sleep apnea, or other diseases aggravated by obesity.

The best candidates for diabetes remission tend to be those with shorter disease duration, who are not yet using insulin, and who retain pancreatic reserve (the pancreas's ability to produce insulin). However, even patients with long-standing diabetes can benefit significantly from surgery in terms of glycemic control and medication reduction.

Recommended Procedures for Diabetes

The procedures with the strongest evidence for type 2 diabetes control are:

• Gastric bypass (Roux-en-Y): considered the procedure with the strongest evidence for diabetes remission. It combines gastric restriction with malabsorption and significant hormonal changes.
• Mini gastric bypass (OAGB): metabolic results similar to traditional bypass, with a single-anastomosis technique.
• Gastric sleeve: also produces significant diabetes improvement in many patients, although remission rates tend to be lower than with bypass.

Procedure selection depends on each patient's clinical profile, including BMI, diabetes duration, current medications, presence of reflux, and other factors. Dr. Monroy evaluates each case individually.

Results and Expectations

Results of surgery on diabetes control vary by patient. Factors that influence prognosis include:

• Diabetes duration: patients diagnosed less than 5 years ago have higher chances of remission.
• Insulin use: patients who do not require insulin before surgery have better outcomes.
• Pancreatic reserve: the pancreas's ability to produce insulin is a determining factor.
• Follow-up adherence: diet, exercise, and ongoing medical monitoring are essential to maintain results.

After surgery, patients with diabetes require close metabolic follow-up to adjust medications, monitor glucose levels, and ensure changes are maintained long term. Dr. Monroy works in coordination with endocrinologists and internists when necessary.

Can I stop taking diabetes medications after surgery?

Many patients achieve reduction or discontinuation of their diabetes medications after surgery, but this must be done exclusively under medical supervision. Medication adjustments begin during hospitalization and continue at follow-up appointments, based on each patient's glucose and glycosylated hemoglobin levels.

What if I have had diabetes for many years?

Patients with long-standing diabetes can also benefit from surgery, although the chances of complete remission are lower. Even when it is not possible to stop all medications, surgery can significantly improve glycemic control, reduce insulin doses, and decrease the risk of complications such as neuropathy, retinopathy, and cardiovascular disease.