Mixed

Bariatric surgery (Roux-en-Y gastric bypass and sleeve gastrectomy) provides long-term weight loss and high diabetes remission rates (51% at 12 years) by altering gut microbiota diversity and increasing specific beneficial bacteria like Bacteroides uniformis.

For severe obesity with type 2 diabetes, bariatric surgery (Roux-en-Y or Sleeve Gastrectomy) is the most effective long-term treatment, offering sustained weight loss (~35kg) and a 51% chance of diabetes remission after 12 years. This is achieved partly by reshaping the gut microbiome to favor beneficial bacteria.