Fig. 1Common metabolic procedures in Asia.
Table 1Type 2 diabetes mellitus outcomes after laparoscopic sleeve gastrectomy in Asian (by BMI and follow-up time)
Study |
Case no. |
Age, yr |
BMI, kg/m2
|
Duration of T2DM, yr |
HbA1c, % |
T2DM remission rate (HbA1c),% |
Follow-up, yr |
<7 |
<6.5 |
<6.0 |
Lee et al. (2010) [16] |
20 |
45.0±10.8 |
28.5±3.3 |
7.9±5.1 |
9.3±0.8 |
- |
50 |
- |
1 |
Lee et al. (2011) [12] |
30 |
45 |
30.3 |
NR |
10.0 |
- |
47 |
- |
1 |
Park et al. (2015) [20] |
11 |
35.8±10.2 |
32.7±1.6 |
NR |
8.0 |
- |
- |
82 |
1 |
Lee et al. (2016) [22] |
109 |
43.2±11.0 |
35.7±7.2 |
3.3±3.5 |
8.8±1.5 |
- |
- |
56 |
1 |
Liu et al. (2015) [19] |
65 |
40.9±10.0 |
40.6±6.2 |
4.5 |
8.2±1.8 |
80.9 |
34.5 |
34.5 |
1 |
Lee et al. (2012) [18] |
20 |
44.4±11.9 |
40.7±6.6 |
NR |
9.1±1.2 |
- |
72.7 |
- |
1 |
Lakdawala et al. (2011) [21] |
14 |
27 |
42 |
NR |
NR |
78.6 |
- |
- |
1 |
Park et al. (2015) [20] |
143 |
32.2±9.3 |
42.6±6.6 |
NR |
7.1 |
- |
- |
83 |
1 |
Shah et al. (2010) [15] |
53 |
46.5±8.7 |
45.2±9.3 |
4.2±5.0 |
8.4±1.6 |
- |
96.2 |
- |
1 |
Kasama et al. (2008) [17] |
6 |
38±10 |
49.1±10 |
NR |
NR |
88.9 |
- |
- |
1 |
Tang et al. (2016) [29] |
34 |
36.6±8.0 |
38.4±8.6 |
5.1±4.1 |
7.4±1.8 |
- |
76.5 |
50 |
2 |
Wong et al. (2012) [30] |
24 |
NR |
40±6.7 |
5.9±6.4 |
7.9±2.4 |
85.7 |
71.4 |
58.3 |
2 |
Yang et al. (2015) [28] |
32 |
40.4±9.4 |
31.8±3.0 |
4.0±1.7 |
8.5±1.2 |
- |
89.3 |
78.6 |
3 |
Liu et al. (2015) [19] |
39 |
40.9±10.0 |
40.6±6.2 |
4.5 |
8.2±1.8 |
74.2 |
52.7 |
47.2 |
3 |
Todkar et al. (2010) [23] |
23 |
44.6±11.9 |
40.7±6.6 |
NR |
NR |
- |
72.7 |
- |
3 |
Lee et al. (2014) [24] |
30 |
46.4±8.1 |
31.0±2.8 |
6.9±5.3 |
9.9±1.8 |
- |
36.7 |
6.7 |
5 |
Jammu et al. (2016) [27] |
23 |
23 |
35 |
NR |
NR |
- |
56.5 |
- |
5 |
Lee et al. (2016) [22] |
109 |
43.2±4.0 |
35.7±7.2 |
33±3.5 |
3.8±1.5 |
- |
- |
56 |
5 |
Zhang et al. (2014) [25] |
9 |
29.3±9.8 |
38.5±4.2 |
NR |
9.1±1.2 |
- |
67 |
- |
5 |
Liu et al. (2015) [19] |
19 |
40.9±10.0 |
40.6±6.2 |
4.5 |
8.2±1.8 |
78.6 |
70.6 |
64.7 |
5 |
Kular et al. (2014) [26] |
61 |
NR |
42±5.2 |
NR |
NR |
81 |
- |
- |
5 |
Table 2Type 2 diabetes mellitus outcomes after gastric bypass in Asian (by BMI and follow-up time)
Study |
Case no. |
Age, yr |
BMI, kg/m2
|
Duration of T2DM, yr |
HbA1c, % |
T2DM remission rate (HbA1c),% |
Follow-up, yr |
<7 |
<6.5 |
<6.0 |
Kim et al. (2011) [33] |
10 |
46.9 |
27.2 |
6.6 |
9.7 |
60 |
- |
- |
0.5 |
Shah et al. (2010) [34] |
15 |
45.6±12.0 |
28.9±4.0 |
8.7±5.3 |
10.1±2.0 |
- |
100 |
- |
0.75 |
Malapan et al. (2014) [35] |
29 |
53 |
24.4±1.8 |
5.5 |
10±1.8 |
- |
37.9 |
- |
1 |
Liang et al. (2015) [43] |
86 |
48.5 |
24.7±2.1 |
8.6±2.0 |
6.8±4.0 |
- |
- |
23.3 |
1 |
Kim et al. (2014) [36] |
172 |
46±11 |
25.3±3.2 |
9.6±5.2 |
9.0±1.7 |
53 |
- |
- |
1 |
Dixon et al. (2013) [37] |
103 |
47.5±9.6 |
26.0±3.0 |
7.1±1.6 |
9.1±1.6 |
67 |
- |
30.1 |
1 |
Zhu et al. (2012) [38] |
30 |
48.2±8.2 |
26.2±3.6 |
6.0±4.5 |
8.0±1.8 |
- |
30 |
- |
1 |
Lee et al. (2011) [12] |
30 |
44.6±8.6 |
30.2±2.2 |
5.8±5.7 |
10.0±1.8 |
- |
93 |
- |
1 |
Huang et al. (2011) [39] |
22 |
47.4±11.2 |
30.8±3.2 |
9.2 |
6.6±6.3 |
90.9 |
- |
63.6 |
1 |
Liang et al. (2013) [40] |
31 |
50.8±5.4 |
30.5±0.9 |
2.4±1.7 |
10.5±1.2 |
- |
90 |
- |
1 |
Lakdawala et al. (2013) [42] |
52 |
49 |
32.6 |
8.4 |
8.8 |
96.2 |
73.1 |
- |
1 |
Dixon et al. (2013) [41] |
154 |
39.5±10.7 |
37.2±8.8 |
2.0 |
9.1±1.7 |
88 |
69.5 |
- |
1 |
Park et al. (2015) [20] |
134 |
42.3±11.1 |
37.9±5.2 |
4.6±5.8 |
8.0±1.5 |
- |
61.8 |
46.1 |
1 |
Kim et al. (2011) [33] |
116 |
46±11 |
25.3±3.2 |
9.6±5.2 |
9.0±1.7 |
63 |
- |
- |
2 |
Ikramuddin et al. (2016) [3] |
14 |
45.7±7.9 |
31.9±1.7 |
6.1±3.6 |
9.6±1.1 |
86 |
57 |
29 |
2 |
Tang et al. (2016) [29] |
38 |
40.4±12.3 |
37.8±5.6 |
6.5±4.1 |
7.4±1.8 |
- |
57.9 |
36.8 |
2 |
Yang et al. (2015) [28] |
32 |
41.4±9.3 |
32.3±2.4 |
4.2±1.9 |
8.9±1.3 |
- |
92.6 |
85.2 |
3 |
Lee et al. (2014) [24] |
30 |
44.6±8.6 |
30.2±2.2 |
5.8±5.7 |
10.0±1.8 |
- |
60.0 |
26.7 |
5 |
Lee et al. (2016) [22] |
470 |
41.8±10.9 |
36.9±7.2 |
4.5±4.8 |
8.6±1.7 |
- |
- |
63.8 |
5 |
Zhang et al. (2014) [25] |
8 |
32.2 |
39.3±3.8 |
NR |
NR |
87.5 |
- |
- |
5 |
Lakdawala et al. (2013) [42] |
52 |
49 |
32.6 |
8.4 |
8.8 |
96.2 |
57.7 |
- |
5 |
Kular et al. (2014) [26] |
63 |
NR |
44±3.1 |
NR |
NR |
92 |
- |
- |
5 |
Jammu et al. (2016) [27] |
95 |
42 |
50 |
NR |
NR |
- |
88.4 |
- |
5 |
Table 3Type 2 diabetes mellitus remission of bariatric surgery versus medical treatment in Asian and non-Asian populations
Study |
Study recruitment year |
Country |
Study type |
Intervention (n) |
Patients |
Follow-up duration |
Outcomes on DM remission |
Ikramuddin et al. (2016) [3] |
2008–2011 |
Taiwan and USA |
RCT |
Medical (16) RYGB (14) |
T2DM with BMI 30–35 kg/m2
|
2 yr |
DM remission: 0% vs. 90% |
Liang et al. (2013) [40] |
2008–2011 |
China |
RCT |
Usual care (36) Exenatide (34) RYGB (31) |
T2DM with BMI >28 kg/m2
|
1 yr |
DM remission: 0% vs. 0% vs. 57% |
Palikhe et al. (2014) [50] |
2011–2012 |
India |
RCT |
Intensive Medical therapy(17) LSG (14) |
T2DM with BMI ≥27.5 kg/m2
|
1 yr |
DM resolution: 0% vs. 39% |
Heo et al. (2012) [54] |
2008–2011 |
Korea |
Retrospective cohort study |
Weight control medication and lifestyle modification therapy (224) Bariatric surgery (261) |
Obese patients with or without comorbids |
18 mo |
DM resolution: 10% vs. 57% |
Cummings et al. (2016) [51] |
2011–2012 |
USA |
RCT |
ILMI (20) RYGB (23) |
T2DM with BMI <35 kg/m2
|
1 yr |
Diabetes remission: 5.9% vs. 60.0% |
Mingrone et al. (2015) [52] |
2009 |
Italy |
RCT |
Medical treatment (20) RYGB (20) Biliopancreatic diversion (20) |
T2DM with BMI ≥35 kg/m2
|
5 yr |
Diabetes remission at 5 years: 0% vs. 37% vs. 63% Relapse of hyperglycaemia in patients who achieved 2 year remission: RYGB (53%) vs. BPD (37%) |
Schauer et al. (2014) [4] |
2007–2011 |
USA |
RCT |
Intensive medical therapy alone (50) RYGB (50) LSG (50) |
T2DM with BMI 27–43 kg/m2
|
1 yr |
DM remission: 12% vs. 42% vs. 37% |
Ikramuddin et al. (2016) [3] |
2008–2010 |
USA |
RCT |
LS/IMM (60) RYGB (60) |
T2DM with BMI 30–39.9 kg/m2
|
1 yr |
Achieved primary composite end point (HbA1c <7.0%, LDL-C <100 mg/dL, and SBP <130 mm Hg): 19% vs. 49% HbA1c <7.0%: 32% vs. 75% |
Dixon et al. (2008) [53] |
2006–2008 |
Australia |
RCT |
Medical/conventional (30) LAGB (30) |
T2DM with BMI
>30 to <40 kg/m2
|
2 yr |
DM remission: 13% vs. 73% |
Table 4Randomized trials on metabolic surgery in Asia
Study |
Year |
Country |
Patients |
Follow-up duration, yr |
Intervention (n) |
Outcomes |
Conclusion |
Lee et al. (2011) [12] |
2007–2008 |
Taiwan |
T2DM with BMI 25–35 kg/m2
|
5 |
LSG (30) SAGB(30) |
DM remission 30% vs. 60% Similar weight loss SAGB group had a higher incretin effect than the SG |
SAGB was more likely to achieve better glycemic control than SG |
Ikramuddin et al. (2016) [3] |
2008–2011 |
Taiwan and USA |
T2DM with BMI 30–35 kg/m2
|
2 |
Medical (16) RYGB (14) |
DM remission 0% vs. 0% vs. 90% Better weight loss in RYGB |
RYGB was more likely to achieve better glycemic control than medical treatment in both Taiwanese and American mild obese subjects with T2DM |
Kasama et al. (2008) [17] |
2008–2011 |
China |
T2DM with BMI >28 kg/m2
|
1 |
Usual care (36) Exenatide (34) RYGB (31) |
DM remission 0% vs. 57% Significant decrease in hypertension medication in RYGB |
RYGB improves a number of parameters including cardiovascular function in obese hypertensive people with T2DM |
Yang et al. (2015) [28] |
2009–2014 |
China |
T2DM with BMI 28–35 kg/m2
|
3 |
LSG (32) RYGB (32) |
DM remission 78.6% vs. 85.2% had %EWL 92.3% vs. 81.9% Similar improvement in serum lipids |
SG had similar positive effects on diabetes and dyslipidemia compared to RYGB |
Tang et al. (2016) [29] |
2011–2013 |
China |
T2DM with BMI >28 kg/m2
|
2 |
LSG (34) RYGB (38) |
DM remission is comparable 50% vs. 36.8% Similar weight loss: cost-effectiveness |
LSG is a cost-effective intervention for managing T2DM |