Metabolic surgery for type 2 diabetes with BMI <35 kg/m(2) : an endocrinologist's perspective

Abstract

Is bariatric surgery as primary therapy for type 2 diabetes mellitus (T2DM) with body mass index (BMI) <35 kg/m(2) justified? Open-label studies have shown that bariatric surgery causes remission of diabetes in some patients with BMI <35 kg/m(2). All such patients treated had substantial weight loss. Diabetes remission was less likely in patients with lower BMI than those with higher BMI, in patients with longer than shorter duration and in patients with lesser than greater insulin reserve. Relapse of diabetes increases with time after surgery and weight regain. Deficiencies of data are lack of randomized long-term studies comparing risk/benefit of bariatric surgery to contemporary intensive medical therapy. Current data do not justify bariatric surgery as primary therapy for T2DM with BMI <35 kg/m(2).

Fig. 1

The results of metabolic surgery in patients with type 2 diabetes and BMI <35 kg/m². The data are the result of meta-analyses from 14 studies for the change in BMI, 12 studies for the change in fasting plasma glucose (FPG) and ten studies for the change in HbA1C. Data are derived from Shimizu et al. [31]

Fig. 2

The relationship between baseline BMI and baseline duration of known diabetes with the percent of patients with remission of their diabetes 1 year after metabolic surgery. The data are derived from 87 of 200 patients who had achieved a 1-year follow-up in a multi-institutional international Asian study. Data are derived from Lee et al. [29]