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Metabolic Surgery for Diabetes — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicineMetabolic Surgery for DiabetesRACP Adult Medicine

A 50-year-old man with a BMI of 45 and type 2 diabetes (HbA1c 80 mmol/mol on triple oral therapy) is considering bariatric surgery. According to current guidelines, what BMI threshold is required for metabolic surgery in patients with type 2 diabetes?

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Correct answer: D — BMI ≥30 with uncontrolled diabetes on maximal medical therapy

Current guidelines (IFSO, ADS/ANZMOSS) support metabolic/bariatric surgery for patients with T2DM and BMI ≥30 (or ≥27.5 in Asian populations) who have inadequately controlled diabetes despite optimised medical therapy. The STAMPEDE trial showed sustained diabetes remission at 5 years post-surgery. In Australia, PBS and MBS criteria support surgical eligibility at these thresholds. Surgery achieves superior glycaemic control, weight loss, and cardiovascular risk reduction compared to medical therapy alone.

Reference: ADS/ANZMOSS – 2024 – Metabolic Surgery Position Statement; eTG – 2025 – Endocrinology