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

Abstract

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) < 30kg/m2 especially Asian population has not been widely reported and acknowledged. 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 < 30kg/m2 from Asian countries or regions were included in this meta-analysis. Twelve studies including 697 patients were examined in this meta-analysis. Clinical indexes in 6, 12, and 24months follow-up were analyzed, respectively. BMI and waist circumference reduced by 2.88kg/m2 and 12.92cm, respectively, at 12months 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, 3.13mmol/L, 5.46mmol/L, and 2.13% at 6months; 3.22mmol/L, 6.46mmol/L, and 2.38% at 12months; 1.99mmol/L, 5.84mmol/L, and 1.58% at 2years. Insulin only reduced by 1.70μU/ml at 12months. C-peptide reduced by 0.70ng/ml and 0.40ng/ml at 6months and 2years. Bariatric surgery led to reduction in total cholesterol, triglyceride, and low-density lipoprotein cholesterol, while augment in high-density lipoprotein cholesterol at 6 and 12months. Glucagon-like peptide 1 increased by 2.48pmol/L and 4.00pmol/L at half a year 1year. Asian patients with type 2 diabetes and BMI < 30kg/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.