Obesity Surgery

, Volume 20, Issue 6, pp 776–790 | Cite as

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

  • M. FriedEmail author
  • G. Ribaric
  • J. N. Buchwald
  • S. Svacina
  • K. Dolezalova
  • N. Scopinaro


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.


Bariatric Metabolic surgery Type 2 diabetes Biliopancreatic diversion Gastric bypass Laparoscopic adjustable gastric banding Sleeve gastrectomy Ileal interposition 



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


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


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Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • M. Fried
    • 1
    • 2
    Email author
  • G. Ribaric
    • 3
  • J. N. Buchwald
    • 4
  • S. Svacina
    • 5
  • K. Dolezalova
    • 1
  • N. Scopinaro
    • 6
  1. 1.Centre for Treatment of Obesity and Metabolic Disorders, OB klinikaPrague 3Czech Republic
  2. 2.First Faculty of MedicineCharles UniversityPragueCzech Republic
  3. 3.European Surgical Institute, Ethicon Endo-Surgery (Europe) GmbHHamburgGermany
  4. 4.Medwrite Medical Communications, LLCMaiden RockUSA
  5. 5.Third Medical Department, Clinical Department of Endocrinology and Metabolism of the First Faculty of Medicine and General University HospitalPragueCzech Republic
  6. 6.University of Genoa School of MedicineGenoaItaly

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