On May 26, 2016, Nature—one of the most prestigious scientific journals in the world—published a powerful and provocative article by Dr. Francesco Rubino titled “Time to Think Differently About Diabetes.” In it, Dr. Rubino calls for a bold reevaluation of how we understand and treat type 2 diabetes mellitus (T2DM). His message is clear: metabolic surgery for type 2 diabetes, long viewed as a last resort for obese patients, must now be considered a legitimate and effective therapy—even in patients who are not severely obese.
This article is more than an academic statement. It is a declaration of paradigm shift.
Who Is Dr. Francesco Rubino?
Dr. Rubino is one of the world’s leading authorities on metabolic and bariatric surgery. He is Professor of Metabolic and Bariatric Surgery at King’s College London and Consultant Surgeon at King’s College Hospital. Most notably, he is the principal architect and organizer of the Diabetes Surgery Summit, which first convened in 2007 and again in 2015 to develop formal clinical guidelines for the use of gastrointestinal surgery in diabetes treatment.
Dr. Rubino’s career has been defined by a single, disruptive question: What if diabetes is not just a disease of the pancreas or fat tissue—but also of the gut?
What Does the Nature Article Say About Metabolic Surgery for Type 2 Diabetes?
Dr. Rubino’s commentary explains how new global guidelines—endorsed by 45 scientific societies—now recognize metabolic surgery for type 2 diabetes as a standard treatment option for people who are not responding adequately to medications and lifestyle changes.
He recounts nearly a century of overlooked clinical evidence that diabetes can improve dramatically after gastrointestinal operations. While these effects were long attributed to weight loss, Dr. Rubino argues that this assumption was overly simplistic. Instead, modern studies, including randomized clinical trials and mechanistic investigations, now show that surgery affects diabetes through direct alterations in gut anatomy and hormone signaling—well beyond the effect of body weight alone.
“These recommendations arguably signify the most radical departure from mainstream approaches to the management of diabetes since the introduction of insulin in the 1920s,” he writes.
Why Is This Important for Patients?
For patients who feel stuck in the exhausting cycle of medications, glucose monitoring, and constant dietary vigilance, this article offers both a scientific breakthrough and a message of hope: remission is possible.
Dr. Rubino reminds us that up to 80% of patients undergoing metabolic surgery for type 2 diabetes achieve either complete remission or major improvement—even five years after the procedure. Some patients stop needing insulin altogether. In randomized trials, surgery consistently outperforms drug therapy and lifestyle interventions. Importantly, surgery works through mechanisms that affect insulin sensitivity, gut hormones, bile acids, and even the microbiome.
These results have led more clinicians to consider metabolic surgery for type 2 diabetes not only as a treatment of last resort, but as a first-line option in selected patients.
For patients with a BMI above 30 (or 27.5 for Asian individuals), who cannot adequately control their blood sugar despite conventional treatment, metabolic surgery for type 2 diabetes should now be seen not as a last resort, but as a medically appropriate and biologically targeted option.
Why Does the Nature Platform Matter?
The fact that this article appeared in Nature is not incidental. Nature is a global, interdisciplinary scientific journal with rigorous peer review and an enormous academic and clinical readership. It typically publishes groundbreaking discoveries—not clinical commentary. The presence of Rubino’s article in this venue marks a watershed moment: the global scientific community is being asked to rethink the pathogenesis and treatment of diabetes at its very foundation.
Publishing in Nature ensures that the conversation about metabolic surgery for type 2 diabetes is no longer confined to surgical journals—it becomes relevant to internists, endocrinologists, neuroscientists, and public health leaders.
Final Thoughts: A New Chapter in Diabetes Care
The recognition of metabolic surgery for type 2 diabetes as a powerful therapeutic tool marks a turning point in how we address the root causes of the disease.
At diabetes.surgery, we embrace this new vision. As Dr. Rubino writes:
“The story of surgery and diabetes shows how important it is to have both imagination and knowledge.”
We must now summon the courage to apply both.
Let’s stop seeing surgery as failure—and start seeing it as a scientifically grounded, biologically targeted therapy. The gut is not just a passive player in glucose control—it may be the master regulator we’ve overlooked for too long.
This is more than a clinical pivot. It is a call to action for doctors and patients alike
