Bariatric Surgery for Type 2 Diabetes Mellitus in Patients with BMI <30 kg/m2: A Systematic Review and Meta-Analysis

Abstract

Background and ObjectiveThe role of bariatric surgery in non-obese patients with type 2 diabetes (T2DM) remains unclear, and its use in clinical practice is controversial. We conducted a systemic review and meta-analysis to investigate the metabolic changes after surgical treatment in diabetic patients with body mass index (BMI) <30 kg/m2.MethodsWe conducted a comprehensive search in MEDLINE (PubMed), EMBASE and the Cochrane Library of published articles from January 2000 to April 2013 reporting the clinical outcome changes in various metabolic outcomes in diabetic patients with BMI <30 kg/m2.ResultsTen prospective studies including 290 patients were included in the meta-analysis. Bariatric surgery led to an overall 2.79 kg/m2 [95%CI 2.05~3.53, P<0.00001] reduction in BMI, a 1.88%[95%CI 1.32~2.43, P<0.00001] reduction in glycosylated hemoglobin, a 3.70 mmol/L [95%CI, 1.93~5.47, P<0.00001] reduction in fasting blood glucose, a 6.69 mmol/L [95%CI, 2.29~11.08, P=0.003] reduction in postprandial glucose, anda 3.37 [95%CI 0.55~6.18, P=0.02] reduction in homeostasis model assessment of insulin resistance (HOMA-IR). After surgical treatment, 76.2% of the patients were insulin free, and 61.8% patients were off medication. In total, 90(42.4%), 10(37%) and 34(37.2%) patients had post-surgical HbA1c levels of <6%,<6.5% and<7%, respectively. No deaths were observed in the included studies, and the major complication rate was 6.2%.ConclusionsBased on the currently available data, bariatric surgery might improve glycemic control and weight loss in a very limited range with a doubled surgical complication rate in drug-refractory T2DM patients with BMI <30 kg/m2. It remains too premature to suggest bariatric surgery for non-obese T2DM patients.

Bariatric surgery for nonalcoholic steatohepatitis: A clinical and cost‐effectiveness analysis

“…At present, recommendations for bariatric surgery are restricted to patients with body mass index (BMI) ≥40 or ≥35 with obesity‐related comorbidities . However, specific patient groups with lower BMIs and severe metabolic derangements, such as individuals with diabetes, may also benefit from weight loss surgery . Given the limited medical options for treating NASH, there is growing interest in a potential role for bariatric surgery as therapy for patients with NASH and nonmorbid obesity, although the data in this population are limited .…”

Metabolic Surgery for the Treatment of Diabetes Mellitus Positioning of Leading Medical Associations in Mexico

“…. In a recent meta-analysis of studies that included 290 patients with DM2 and BMI < 30 kg/m 2 , a significant improvement in HbA1c, fasting glycemia, postprandial glycemia, and HOMA-IR after surgery [54] was observed. Remission was 42%, but the higher complication rate was 6.2%, almost double that reported in patients with higher BMI levels.…”

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.…”