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Obesity Surgery
Published in: Obesity Surgery 6/2010

01-06-2010 | Review

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

Authors: M. Fried, G. Ribaric, J. N. Buchwald, S. Svacina, K. Dolezalova, N. Scopinaro

Published in: Obesity Surgery | Issue 6/2010

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Abstract

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.
Literature
1.
North American Association for the Study of Obesity (NAASO) and the National Heart, Lung, and Blood Institute (NHLBI). The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. NIH Publication #00-4084, October 2000.
2.
Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.CrossRefPubMed
3.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMed
4.
Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240:416–23.CrossRefPubMed
5.
Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.e5. Review.CrossRefPubMed
6.
Pontiroli AE, Folli F, Paganelli M, et al. Laparoscopic gastric banding prevents type 2 diabetes and arterial hypertension and induces their remission in morbid obesity: a 4-year case-controlled study. Diabetes Care. 2005;28(11):2703–9.CrossRefPubMed
7.
Von Mering JV, Minkowski O. Diabetes nach pankreas extirpation. Arch Exp Path Pharmakol. 1889;26:371.
8.
Barron M. The relation of the islets of langerhans to diabetes with special reference to cases of pancreatic lithiasis. Surg, Gynecol and Obstetrics. 1920;31(5):437–48.
9.
Banting FG, Best CH, Collip JB, et al. Pancreatic extracts in the treatment of diabetes mellitus: preliminary report. CMAJ. 1922;12(3):141–6.
10.
Friedman MN, Sancetta AJ, Magovern GJ. The amelioration of diabetes mellitus following subtotal gastrectomy. Surg Gynecol Obstet. 1955;100(2):201–4.PubMed
11.
Bosello O, Armellini F, Pelloso M, et al. Glucose tolerance in jejunoileal bypass for morbid obesity: a fifteen month follow-up. Diabetes Metab. 1978;4(3):159–62.
12.
Ackerman NB. Observations on the improvements in carbohydrate metabolism in diabetic and other morbidly obese patients after jejunoileal bypass. Surg Gynecol Obstet. 1981;152(5):581–6.PubMed
13.
Halverson JD, Kramer J, Cave A, et al. Altered glucose tolerance, insulin response, and insulin sensitivity after massive weight reduction subsequent to gastric bypass. Surgery. 1982;92(2):235–40.PubMed
14.
Herbst CA, Hughes TA, Gwynne JT, et al. Gastric bariatric operation in insulin-treated adults. Surgery. 1984;95:209–13.PubMed
15.
Schrumpf E, Bergan A, Djoseland O, et al. The effect of gastric bypass operation on glucose tolerance in obesity. Scand J Gastroenterol. 1985;20 Suppl 107:24–31.CrossRef
16.
Scopinaro N, Gianetta E, Civalleri D, et al. Biliopancreatic bypass for obesity: I. An experimental study in dogs. Br J Surg. 1979;66:613–7.CrossRefPubMed
17.
Scopinaro N, Gianetta E, Civalleri D, et al. Biliopancreatic bypass for obesity: II. Initial experience in man. Br J Surg. 1979;66:618–20.CrossRefPubMed
18.
Scopinaro N, Gianetta E, Friedman D, et al. Evolution of biliopancreatic bypass. Clin Nutr. 1986;5(Suppl):137–46.
19.
Pories WJ, Caro JF, Flickinger EG, et al. The control of diabetes mellitus (NIDDM) in the morbidly obese with the Greenville Gastric Bypass. Ann Surg. 1987;206(3):316–23.CrossRefPubMed
20.
Jimenez J, Zuniga-Guajardo S, Zinman B, et al. Effects of weight loss in massive obesity on insulin and C-peptide dynamics: sequential changes in insulin production, clearance, and sensitivity. J Clin Endocrinol Metab. 1987;64(4):661–8.CrossRefPubMed
21.
Pories WJ, MacDonald Jr KG, Flickinger EG, et al. Is type II diabetes mellitus (NIDDM) a surgical disease? Ann Surg. 1992;215(6):633–42. discussion 643.CrossRefPubMed
22.
Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–52.CrossRefPubMed
23.
Maggard M, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.PubMed
24.
Sjöström CD, Lissner L, Wedel H, et al. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res. 1999;7(5):477–84.PubMed
25.
Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237(6):751–6. discussion 757–8.CrossRefPubMed
26.
Dixon JB, Dixon ME, O’Brien PE. Quality of life after Lap-Band placement: influence of time, weight loss, and comorbidities. Obes Res. 2001;9(11):713–21.CrossRefPubMed
27.
Sjöström L, Narbro K, Sjöström CD. Effects of bariatric surgery on mortality in Swedish obese subjects. NEJM. 2007;357(8):741–52.CrossRefPubMed
28.
Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543–51.CrossRefPubMed
29.
Lara MD, Kothari SN, Sugerman HJ. Surgical management of obesity: a review of the evidence relating to the health benefits and risks. Treat Endocrinol. 2005;4(1):55–64. Review.CrossRefPubMed
30.
Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142:621–35.CrossRefPubMed
31.
Sampalis JS, Liberman M, Auger S, et al. The impact of weight reduction surgery on health-care costs in morbidly obese patients. Obesity Surg. 2004;14(7):939–47.CrossRef
32.
Finkelstein EA, Brown DS. Return on investment for bariatric surgery. Am J Managed Care. 2008;14(9):561–2.
33.
Cremieux PY, Buchwald H, Shikora SA, et al. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008;14(9):589–96.PubMed
34.
Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998;22:936–46.CrossRefPubMed
35.
Hickey MS, Pories WJ, MacDonald Jr KG, et al. A new paradigm for type 2 diabetes mellitus: could it be a disease of the foregut? Ann Surg. 1998;227:637–43.CrossRefPubMed
36.
Gumbs A, Modlin IM, Ballantyne GH. Changes in insulin resistance following bariatric surgery: role of caloric restriction and weight loss. Obes Surg. 2005;15:462–73.CrossRefPubMed
37.
Brolin RE. Update: NIH consensus conference. Gastrointestinal surgery for severe obesity. Nutrition. 1996;12:403–4.CrossRefPubMed
38.
Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236:554–9.CrossRefPubMed
39.
Levy P, Fried M, Santini F, et al. The comparative effects of bariatric surgery on weight and type 2 diabetes. Obes Surg. 2007;17(9):1248–56. Review.CrossRefPubMed
40.
Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–29.CrossRefPubMed
41.
Scopinaro N, Gianetta E, Adami GF, et al. Biliopancreatic diversion for obesity at eighteen years. Surgery. 1996;119(3):261–8.CrossRefPubMed
42.
Buchwald H, Buchwald JN. Evolution of surgery for morbid obesity. In: Pitombo C, Jones KB, Higa KD, Pareja JC, editors. Obesity Surgery: Principles and Practice. New York: McGraw-Hill Medical; 2007. p. 3–14.
43.
Pories WJ. Why does the gastric bypass control type 2 diabetes mellitus? Obes Surg. 1992;2:303–13.CrossRefPubMed
44.
Cowan GS, Buffington CK. Significant changes in blood pressure, glucose, and lipids with gastric bypass surgery. World J Surg. 1998;22:987–92.CrossRefPubMed
45.
Segal JB, Clark JM, Shore AD. Prompt reduction in use of medications for comorbid conditions after bariatric surgery. Obes Surg. 2009;19:1646–56.CrossRefPubMed
46.
Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab. 2004;89:2608–15.CrossRefPubMed
47.
Ferrannini E, Mingrone G. Impact of different bariatric surgical procedures on insulin action and beta-cell function in type 2 diabetes. Diabetes Care. 2009;32:514–20.CrossRefPubMed
48.
Vencio S, De Paula A, Macedo A, et al. Effect of laparoscopic ileal interposition on beta cell function and insulin sensitivity in nonobese patients with type 2 diabetes mellitus. Diabetologia. 2009;52 Suppl 1:S44.
49.
Mingrone G. Role of the incretin system in the remission of type 2 diabetes following bariatric surgery. Nutr Metab Cardiovasc Dis. 2008;18:574–9.CrossRefPubMed
50.
Polyzogopoulou EV, Kalfarentzos F, Vagenakis AG, et al. Restoration of euglycemia and normal acute insulin response to glucose in obese subjects with type 2 diabetes following bariatric surgery. Diabetes. 2003;52:1098–103.CrossRefPubMed
51.
Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93:2479–85.CrossRefPubMed
52.
Salinari S, Bertuzzi A, Iaconelli A, et al. Twenty-four hour insulin secretion and beta cell NEFA oxidation in type 2 diabetic, morbidly obese patients before and after bariatric surgery. Diabetologia. 2008;51:1276–84.CrossRefPubMed
53.
le Roux CW, Aylwin SJ, Batterham RL, et al. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2006;243(1):108–14.CrossRefPubMed
54.
Buchwald H, Varco RL. Metabolic surgery. New York, NY: Grune & Stratton; 1978.
55.
56.
Buchwald H. Lowering of cholesterol absorption and blood levels by ileal exclusion: experimental basis and preliminary clinical report. Circulation. 1964;29:713–20.PubMed
57.
Koopmans HS, Sclafani A. Control of body weight by lower gut signals. Int J Obes. 1981;5:491–5.PubMed
58.
Mistry SB, Omana JJ, Kini S. Rat models for bariatric surgery and surgery for type 2 diabetes mellitus. Obes Surg. 2009;19:655–60. Review.CrossRefPubMed
59.
Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239(1):1–11.CrossRefPubMed
60.
Rubino F, Zizzari P, Tomasetto C, et al. The role of the small bowel in the regulation of circulating ghrelin levels and food intake in the obese Zucker rat. Endocrinology. 2005;146(4):1745–51.CrossRefPubMed
61.
Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244(5):741–9.CrossRefPubMed
62.
Patriti A, Facchiano E, Annetti C, et al. Early improvement of glucose tolerance after ileal transpositition in a non-obese type 2 diabetes rat model. Obes Surg. 2005;15:1258–64.CrossRefPubMed
63.
Patriti A, Aisa MC, Annetti C, et al. How the hindgut can cure type 2 diabetes. Ileal transposition improves glucose metabolism and beta-cell function in Goto-Kakazaki rats through an enhanced proglucagon gene expression and L-cell number. Surgery. 2007;142:74–85.CrossRefPubMed
64.
Pacheco D, de Luis DA, Romero A, et al. The effects of duodenal-jejunal exclusion on hormonal regulation of glucose metabolism in Goto-Kakizaki rats. Am J Surg. 2007;194(2):221–4.CrossRefPubMed
65.
Wang TT, Hu SY, Gao HD, et al. Ileal transposition controls diabetes as well as modified duodenal jejunal bypass with better lipid lowering in a nonobese rat model of type II diabetes by increasing GLP-1. Ann Surg. 2008;247(6):968–75.CrossRefPubMed
66.
Strader A, Clausen TR, Goodin SZ, et al. Ileal interposition improves glucose tolerance in low dose streptozotocin-treated diabetic and euglycemic rats. Obes Surg. 2009;19:96–104.CrossRefPubMed
67.
National Diabetes Information Clearinghouse. Diagnosis of Diabetes. USDHHS. NIH Publication No. 09–4642; October 2008.
68.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2009;32(1):S62–6.CrossRef
69.
70.
71.
Angrisani L, Favretti F, Furbetta F, et al. Italian Group for Lap-Band System®: results of multicenter study on patients with BMI ≤35 kg/m2. Obes Surg. 2004;14:415–8.CrossRefPubMed
72.
Parikh M, Duncombe J, Fielding GA. Laparoscopic adjustable gastric banding for patients with body mass index of 35 kg/m2. Surg Obes Rel Dis. 2006;2:518–22.CrossRef
73.
Sultan S, Parikh M, Youn H, et al. Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2. Surg Endosc. 2009;23:1569–73.CrossRefPubMed
74.
Cohen R, Pinheiro JS, Correa JL, et al. Laparoscopic Roux-en-Y gastric bypass for BMI <35 kg/m2: a tailored approach. Surg Obes Relat Dis. 2006;2:401–4.CrossRefPubMed
75.
Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI >35 and <35 kg/m2. J Gastrointest Surg. 2008;12:945–52.CrossRefPubMed
76.
DePaula AL, Macedo ALV, Mota BR, et al. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21–29. Surg Endosc. 2009;23:1313–20.CrossRefPubMed
77.
DePaula AL, Macedo ALV, Schraibman V, et al. Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20–34. Surg Endosc. 2009;23:1724–32.CrossRefPubMed
78.
Shah S, Todkar JS, Shah PS, et al. Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index <35 kg/m2. Surg Obes Rel Dis. 2009. doi:10.​1016/​j.​soard.​2009.​08.​009.
79.
Noya G, Cossu ML, Coppola M, et al. Biliopancreatic diversion preserving the stomach and pylorus in the treatment of hypercholesterolemia and diabetes type II: results in the first 10 cases. Obes Surg. 1998;8:67–72.CrossRefPubMed
80.
Cohen RV, Schiavon CA, Pinheiro JS, et al. Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with BMI 22–34: a report of two cases. Surg Obes Relat Dis. 2007;3(2):195–7.CrossRefPubMed
81.
Scopinaro N, Papadia F, Marinari G, et al. Long-term control of type 2 diabetes mellitus and the other major components of the metabolic syndrome after biliopancreatic diversion in patients with BMI <35 kg/m2. Obes Surg. 2007;17:185–92.CrossRefPubMed
82.
Ramos AC, Galvao Neto MP, de Souza YM, et al. Laparoscopic duodenaljejunal exclusion in the treatment of type 2 diabetes mellitus in patients with BMI <30 kg/m2. Obes Surg. 2009;19:307–12.CrossRefPubMed
83.
Geloneze B, Geloneze S, Fiori C, et al. Surgery for nonobese type 2 diabetic patients: an interventional study with duodenal–jejunal exclusion. Obes Surg. 2009;19:1077–83.CrossRefPubMed
84.
Ferzli GS, Dominique E, Ciaglia M, et al. Clinical improvement after duodenojejunal bypass for nonobese type 2 diabetes despite minimal improvement in glycemic homeostasis. World J Surg. 2009;33:972–9.CrossRefPubMed
85.
Chiellini C, Rubino F, Castagneto M, et al. The effect of bilio-pancreatic diversion on type 2 diabetes in patients with BMI <35 kg/m2. Diabetologia. 2000;52:1027–30.CrossRef
86.
Scopinaro N, Adami GF, Papadia FS, et al. Effects of biliopancreatic diversion on type 2 diabetes in patients with BMI 25 to 35 kg/m2. J Clin Endocrinol Metab 2009; submitted.
87.
Fobi M, Lee H, Igwe D, et al. Gastric bypass in patients with BMI <40 but >32 without life-threatening co-morbidities: preliminary report. Obes Surg. 2002;12:52–6.CrossRefPubMed
88.
O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program. Ann Intern Med. 2006;144(9):625–33.PubMed
89.
Dixon JB, O'Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.CrossRefPubMed
90.
Dimick JB, Welch HG, Birkmeyer JD. Surgical mortality as an indicator of hospital quality. JAMA. 2004;292:847–51.CrossRefPubMed
91.
Kolterman OG, Gray RS, Griffin J, et al. Receptor and post-receptor defect tribute to the insulin resistance in non-insulin dependent diabetes mellitus. J Clin Invest. 1981;68:957–69.CrossRefPubMed
92.
Elton CW, Tapscott EB, Pories WJ, et al. Effect of moderate obesity on glucose transport in human muscle. Horm Metab Res. 1994;26:181–3.CrossRefPubMed
93.
Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84.PubMed
94.
Ponce J, Haynes B, Paynter S, et al. Effect of Lap-Band-induced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg. 2004;14(10):1335–42.CrossRefPubMed
95.
Herron D, Tong W. Role of surgery in management of type II diabetes. Mount Sinai Med J. 2009;76:281–93.CrossRef
96.
Dixon J. Obesity and diabetes: the impact of bariatric surgery on type-2 diabetes. World J Surg. 2009;33(10):2014–21.CrossRefPubMed
97.
Cummings D, Overduin J, Foster-Schubert KE, et al. Role of the bypassed proximal intestine in the anti-diabetic effects of bariatric surgery. Surg Obes Relat Dis. 2007;3(2):109–15.CrossRefPubMed
98.
Zimmet P, Turner R, McCarty D, et al. Crucial points at diagnosis. Type 2 diabetes or slow type 1 diabetes. Diabetes Care. 1999;22 Suppl 2:B59–64.PubMed
99.
100.
Himsworth HP. Diabetes mellitus: its differentiation into insulin-sensitive and insulin-insensitive types. Lancet. 1936;i:127–30.CrossRef
101.
National Institutes of Health Consensus Development Panel. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115:956–61.
102.
IFSO Editorial. Statement on patient selection for bariatric surgery. Obes Surg. 1997;7(1):41.CrossRef
103.
Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians of India. 2009;57:163–70.
104.
Razak F, Anand SS, Shannon H, et al. Defining obesity cut points in a multiethnic population. Circulation. 2007;115:2111–8.CrossRefPubMed
105.
Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med. 2002;162:2074–9.CrossRefPubMed
Metadata
Title
Metabolic Surgery for the Treatment of Type 2 Diabetes in Patients with BMI <35 kg/m2: An Integrative Review of Early Studies
Authors
M. Fried
G. Ribaric
J. N. Buchwald
S. Svacina
K. Dolezalova
N. Scopinaro
Publication date
01-06-2010
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 6/2010
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-010-0113-3

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