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Metabolic Surgery for the Treatment of Type 2 Diabetes in Patients with BMI <35 kg/m2: An Integrative Review of Early Studies

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Abstract

Type 2 diabetes mellitus (T2DM) resolution in morbidly obese patients following metabolic surgery suggests the efficacy of T2DM surgery in non-morbidly obese patients (body mass index [BMI] <35 kg/m2). This literature review examined research articles in English over the last 30 years (1979–2009) that addressed surgical resolution of T2DM in patients with a mean BMI <35. Weighted and simple means (95% CI) were calculated to analyze study outcomes. Sixteen studies met inclusion criteria; 343 patients underwent one of eight procedures with 6–216 months follow-up. Patients lost a clinically meaningful, not excessive, amount of weight (from BMI 29.4 to 24.2; −5.1), moving from the overweight into the normal weight category. There were 85.3% patients who were off T2DM medications with fasting plasma glucose approaching normal (105.2 mg/dL, −93.3), and normal glycated hemoglobin, 6% (−2.7). In subgroup comparison, BMI reduction and T2DM resolution were greatest following malabsorptive/restrictive procedures, and in the preoperatively mildly obese (30.0–35.0) vs overweight (25.0–25.9) BMI ranges. Complications were few with low operative mortality (0.29%). Novel and/or known mechanisms of T2DM resolution may be engaged by surgery at a BMI threshold ≤30. The majority of low-BMI patients experienced resolution of laboratory and clinical manifestations of T2DM without inappropriate weight loss.

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Acknowledgments

The authors would like to thank T. McGlennon of M3, LLC, WI, USA for statistical consultation during manuscript development.

Disclosures

This work was supported by Ethicon Endo-Surgery (Europe) GmbH.

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Authors and Affiliations

  1. Centre for Treatment of Obesity and Metabolic Disorders, OB klinika, Pod Krejcarkem 975, 130 00, Prague 3, Czech Republic

    M. Fried & K. Dolezalova

  2. First Faculty of Medicine, Charles University, Prague, Czech Republic

    M. Fried

  3. European Surgical Institute, Ethicon Endo-Surgery (Europe) GmbH, Hamburg, Germany

    G. Ribaric

  4. Medwrite Medical Communications, LLC, Maiden Rock, WI, USA

    J. N. Buchwald

  5. Third Medical Department, Clinical Department of Endocrinology and Metabolism of the First Faculty of Medicine and General University Hospital, Prague, Czech Republic

    S. Svacina

  6. University of Genoa School of Medicine, Genoa, Italy

    N. Scopinaro

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Fried, M., Ribaric, G., Buchwald, J.N. et al. Metabolic Surgery for the Treatment of Type 2 Diabetes in Patients with BMI <35 kg/m2: An Integrative Review of Early Studies. OBES SURG 20, 776–790 (2010). https://doi.org/10.1007/s11695-010-0113-3

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