“Metabolic surgery in Asian patients with type 2 diabetes mellitus and body mass index less than 30kg/m2: A systematic review”

Background

The effect of metabolic surgery on long-term diabetes remission in Asian patients with a body mass index (BMI) < 30 kg/m² has not been widely reported.

Methods

We conducted a systematic review of the PubMed and Cochrane Library databases from inception to June 2024. All clinical trials and observational studies involving the effect of metabolic surgery in Asian patients with type 2 diabetes mellitus and BMI <30 kg/m² were considered. The quality of the studies was assessed using the Newcastle-Ottawa scale.

Results

Of the 1175 studies screened, 21 studies (11 prospective and 10 retrospective), including 1005 patients, were selected. Only one study had a control group. The longest follow-up was 60 months. The results showed significant improvement in glycated hemoglobin (HbA1c), fasting blood glucose (FBG), 2-h plasma glucose (2hPG), homeostasis model assessment for insulin resistance index (HOMA-IR), fasting C-peptide, triglycerides, total cholesterol, and a reduction in the use of oral hypoglycemic agents/insulin at 12, 24, 36, and 60 months after metabolic surgery. The most common surgical complications observed were anemia (2.1 %–33 %), marginal ulcer (4.2 %–17.3 %), gastrointestinal bleeding (1.9 %–12 %), anastomotic leak (2.1 %–3.5 %), anastomotic stenosis (2.1 %–3.5 %), reoperation (1.18 %), and a mortality rate of zero.

Conclusions

Long-term diabetes remission, along with improvements in HbA1c, 2hPG, FBG, and HOMA-IR, with an acceptable rate of complications, was observed in Asian patients with BMI <30 kg/m² after metabolic surgery. Future research with controlled studies should focus on preoperative patient selection criteria beyond just the BMI cutoff.