Review of Metabolic Surgery for Type 2 Diabetes in Patients with a BMI < 35 kg/m²

Abstract

Bariatric/metabolic surgery is considered an accepted treatment option for type 2 diabetes mellitus (T2DM) with body mass index (BMI) ≧ 35 kg/m2. Mounting evidence also shows that metabolic surgery is effective for T2DM with BMI < 35 kg/m2. To evaluate current status of metabolic surgery, we reviewed the available clinical studies which described surgical treatment for T2DM with mean BMI < 35 kg/m2. 18 studies with 477 patients were identified. 30% of the patients was insulin users. The follow-up period ranged from 6 to 216 months. The weight loss effect was reasonable, not excessive. Mean BMI decreased from 30.4 to 24.8 kg/m2. Remission of T2DM was achieved in 64.7% of the patients with fasting plasma glucose and glycated hemoglobin approaching slightly above normal range. Clinical T2DM status was an important factor when selecting the eligible candidates for metabolic surgery. Postoperative complication rate of 10.3% with mortality of 0% in the studies has been acceptable. Even though it would be premature at this point to state that metabolic surgery is an accepted treatment option for T2DM with BMI < 35 kg/m2, it is clear that a high proportion of T2DM patients will derive substantial benefit from metabolic surgery.

Bariatric Surgery in Type 1 Diabetes Mellitus: A Systematic Review

“…Glycaemic control however did not improve to the extent seen with type 2 diabetics. Bariatric or metabolic surgery is increasingly being recognised for even patients with BMI < 35 kg/m 2 and patients with T2DM [42][43][44] (Reviewer 2, Comment 4). This review is not qualified to comment on the role of surgery for non-obese type 1 diabetics but one suspects it will offer limited advantages.…”

Ileal transposition in surgical treatment for type 2 diabetes mellitus

“…В настоящее время мы располагаем данными о приме-нении у пациентов с СД2 и ИМТ<35 кг/м 2 таких операций, как билиопанкреатическое шунтирование (БПШ), тради-ционное ГШ и минигастрошунтирование (МГШ), банда-жирование желудка (БЖ), дуодено-еюношунтирование и ПРЖ [8][9][10]. Одной из операций, которая изначально разрабатывалась как метод хирургического лечения СД2, является илеотранспозиция (ИТ), представляющая собой перемещение участка подвздошной кишки в проксималь-ные отделы тонкой кишки.…”

Bariatric Surgery: The Indications in Metabolic Disease

“…Similar data have been produced elsewhere [30,31,32]. Experimental procedures such as ileal interposition with VSG, designed to test mechanisms of glucose homeostasis rather than weight loss, have been used in cohorts with nonobese and normal BMIs [31,32].…”

“…Experimental procedures such as ileal interposition with VSG, designed to test mechanisms of glucose homeostasis rather than weight loss, have been used in cohorts with nonobese and normal BMIs [31,32]. Both these procedures and classic procedures like RYGB can induce significant changes in metabolic measurements, including glucose homeostasis, blood pressure and lipid profiles, without an increased complication rate [32]. Excessive weight loss is a concern in this group, but is seen in <3% of cases [32].…”

“…Both these procedures and classic procedures like RYGB can induce significant changes in metabolic measurements, including glucose homeostasis, blood pressure and lipid profiles, without an increased complication rate [32]. Excessive weight loss is a concern in this group, but is seen in <3% of cases [32]. …”