The Effect of Bariatric Surgery on Asian Patients with Type 2 Diabetes Mellitus and Body Mass Index < 30 kg/m2: a Systematic Review and Meta-analysis

Obes Surg. 2019 Aug;29(8):2492-2502. doi: 10.1007/s11695-019-03861-0.

Abstract

Background: The effect of bariatric surgery on the glycemic control of patients with obesity and type 2 diabetes mellitus is obvious. However, the effect in patients with body mass index (BMI) < 30 kg/m2 especially Asian population has not been widely reported and acknowledged.

Methods: We performed a literature search in Medline, Embase, and the Cochrane Library from January 2000 to March 2018. All the studies involving the effect of bariatric surgery on patients with type 2 diabetes and BMI < 30 kg/m2 from Asian countries or regions were included in this meta-analysis.

Results: Twelve studies including 697 patients were examined in this meta-analysis. Clinical indexes in 6, 12, and 24 months follow-up were analyzed, respectively. BMI and waist circumference reduced by 2.88 kg/m2 and 12.92 cm, respectively, at 12 months postoperatively. There were reductions in fasting plasma glucose, 2-h postprandial plasma glucose, and glycated hemoglobin A1c at all the three time points after surgery, 3.13 mmol/L, 5.46 mmol/L, and 2.13% at 6 months; 3.22 mmol/L, 6.46 mmol/L, and 2.38% at 12 months; 1.99 mmol/L, 5.84 mmol/L, and 1.58% at 2 years. Insulin only reduced by 1.70 μU/ml at 12 months. C-peptide reduced by 0.70 ng/ml and 0.40 ng/ml at 6 months and 2 years. Bariatric surgery led to reduction in total cholesterol, triglyceride, and low-density lipoprotein cholesterol, while augment in high-density lipoprotein cholesterol at 6 and 12 months. Glucagon-like peptide 1 increased by 2.48 pmol/L and 4.00 pmol/L at half a year 1 year.

Conclusions: Asian patients with type 2 diabetes and BMI < 30 kg/m2 could achieve significant improvement in weight, glycemic control, lipid profiles, and β-cell function in short and medium terms after bariatric surgery, but long-term follow-up is necessary to evaluate the effectiveness.

Keywords: BMI < 30 kg/m2; Bariatric surgery; Type 2 diabetes.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Asian People / statistics & numerical data*
  • Bariatric Surgery / methods*
  • Blood Glucose / metabolism
  • Body Mass Index*
  • C-Peptide / blood
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / ethnology
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetes Mellitus, Type 2 / surgery*
  • Glycated Hemoglobin / metabolism
  • Humans
  • Insulin / blood
  • Lipids / blood
  • Postoperative Period
  • Waist Circumference

Substances

  • Blood Glucose
  • C-Peptide
  • Glycated Hemoglobin A
  • Insulin
  • Lipids