Background
Methods
Search strategy
Screening
Inclusion and exclusion criteria
Literature screening and data extraction
Evidence grade criteria and statistical analysis
Results
Literature search
Laparoscopic metabolic surgery for T2DM in Asia
The distribution of reports on laparoscopic metabolic surgery for T2DM in Asia
The level of clinical study on laparoscopic metabolic surgery for T2DM in Asia
Levels | Type of study | No. of World | No. of Asian | Rates |
---|---|---|---|---|
I 1a | Systematic review/ meta-analysis | 102 | 13 | 12.7% (13/102) |
I 1b | RCT | 52 | 10 | 19.2% (10/52) |
II 2b | Cohort study | 398 | 59 | 14.8% (59/398) |
IV 4 | Case series | 129 | 35 | 27.1% (35/129) |
V 5 | Case report/other | 238 | 88 | 37.0% (88/238) |
The procedures of clinical study on laparoscopic metabolic surgery for T2DM in Asia
Clinical study of laparoscopic metabolic surgery for T2DM with BMI of > 25 kg/m2 to < 35 kg/m2 in Asia
Author/Year | Country | BMI (kg/m2) | Duration of 2TDM (years) | Procedure | No. | Age | Conclusion | Type of study |
---|---|---|---|---|---|---|---|---|
Du 2016 [23] | China | LRYGB 31.20 ± 3.4 LSG 32.1 ± 2.8 | LRYGB 5.0 ± 4.2 LSG 3.5 ± 3.4 | LRYGB LSG | LRYGB 64 (21:43) LSG 19 (4:15) | LRYGB 42.3 ± 9.4 LSG 39.2 ± 9.0 | Both LSG and LRYGB are safe and effective bariatric procedures for T2D with diabetes and BMI <35 kg/m2 | Cohort Study |
Di 2016 [24] | China | 28.2 ± 1.2 | 8.9 ± 5.2 | LRYGB | 66 (30:36) | 50.4 ± 11.4 | RYGB resulted in significant clinical and biochemical improvements in Chinese patients with BMI 25–30 kg/m2 and T2MD: 3 years | Case Series |
Gong 2016 [25] | China | 26.5 ± 1.4 | > 7.3 ± 4.9 | LRYGB | 31 (14:17) | 46 | LRYGB is safe and effective for T2DM patients with BMI < 28 kg/m2 | Case Series |
Kular 2016 [26] | India | 30–35 | 6.5 ± 3.1 | MGB | 128 (46:82) | 41.6 ± 10.2 | MGB provides good, long-term control of T2DM in patients with class I obesity. Early intervention results in higher remission rates. | Case Series |
Li 2016 [27] | China | 24–30 | 9.2 ± 8.1 | LJISSA | 57 (23:34) | 43.1 ± 16.3 | LJISSA seems to be a promising procedure for the control of T2DM | Case Series |
Yang 2015 [28] | China | SG: 31.8 ± 3.0 LRYGB: 32.3 ± 2.4 | SG:4.0 ± 1.7 LRYGB:4.2 ± 1.9: | SG LRYGB | SG:32 (9:23) LRYGB: 32 (12:19) | SG: 40.4 ± 9.4 LRYGB:41.4 ± 9.3 | In this three-year study, SG had similar positive effects on diabetes and dyslipidemia compared to RYGB in Chinese T2DM patients with BMI of 28–35 kg/m2 | RCT |
Yi 2015 [29] | China | LRYGB:25.7 ± 0.9 LRYGBS:26.9 ± 0.7 | LRYGB:5.9 ± 4.5 LRYGBS:6.1 ± 4.7 | LRYGB LRYGBS | LRYGB:30 (22:8) LRYGBS:30 (24:8) | LRYGB:48.2 ± 8.2 LRYGBS:49.1 ± 6.2 | Both procedures are effective treatments for T2DM patients with BMI < 35 kg/m2. LRYGB with a small gastric pouch is more suitable for Chinese diabetic patients with BMI <35 kg/m2. | RCT |
Kim 2014 [30] | Korea | 25.3 ± 3.2 | 9.6 ± 5.2 | LSAGB | 107 (53:54) | 46 ± 11 | After LSAGB surgery in non-obese T2DM patients, the control of T2DM was possible safely and effectively. | Case Series |
Shrestha 2013 [31] | China | 26.71 ± 0.69 | < 10 | LRYGB | 33 (24:9) | 49.51 ± 1.33 | An improvement in postsurgical insulin sensitivity, after LRYGB even in low BMI patients with T2DM. | Case Series |
Lakdawala 2013 [32] | China | 30–35 | 8.4 (3.5–14.5) | LRYGB | 52 (27:25) | 49 (20–65) | LRYGB is a safe, efficacious, and cost-effective treatment for uncontrolled T2DM in patients with a BMI of 30–35 kg/m2 | Case Series |
Wu 2013 [33] | China | 30.15 ± 1.73 | 4.9 ± 2.7 | LRYGB | 8 (2:6) | 42.25 ± 9.95 | Roux-en-Y gastric bypass has a beneficial effect on weight loss and glucose metabolism in obese type 2 diabetes patients with lower BMI | Case Series |
Zhu 2012 [34] | China | 26.20 ± 3.56 | 5.98 ± 4.54 | LRYGB | 30 (22:8) | 48.16 ± 3.56 | LRYGB is beneficial for non-obese T2DM patients in China | Case Series |
Huang 2011 [35] | Taiwan, China | 30.81 (25.00–34.80) | 6.57 (1–20) | LRYGB | 22 (2:20) | 47 (28–63) | Early intervention in low-BMI patients yields better remission rates because age, BMI, and duration of T2DM predict glycemic outcomes. | Case Series |
Lee 2011 [36] | Taiwan, China | 30.1 ± 3.3 | 5.4 ± 5.1 | LRYGB | 62 (24:38) | 43.1 ± 10.8 | Laparoscopic gastric bypass facilitates immediate improvement in the glucose metabolism of inadequately controlled non-severe obese T2DM patients, and the benefit is sustained up to 2 years after surgery | Case Series |
Shah 2010 [37] | India | 28.9 ± 4.0 kg/m2 | 8.7 ± 5.3 | LRYGB | 15 (8:7) | 45.6 ± 12 | LRYGB safely and effectively eliminated T2DM in Asian Indians with BMI < 35 kg/m2 | Case Series |
Lee 2008 [38] | Taiwan, China | 31.7 ± 2.7 | NS | LMGB | 44 (6:38) | 39.0 ± 8.9 | Despite a slightly lower response rate of T2DM treatment, patients with BMI < 35 kg/m2 still had an acceptable DM resolution, and this treatment option can be offered to this group of patients. | Case Series |
Author/Year | Comorbidity | M | Diabetes remission rate | R/C | Major outcomes | Major Complications | Follow-up |
---|---|---|---|---|---|---|---|
Du 2016 [23] | Hypertension, Dyslipidemia Hyperuricemia Sleep apnea | 0 | LRYGB/LSG: 75%/78.9% at 1-year; 57.4% /52.9% at 3-year. | 0 | BMI, FPG, 2 h-PG, HbA1C, FCP, 2 h-CP, FINS, HOMA-IR | one Incomplete intestinal obstruction, one mild upper gastrointestinal bleeding | All completed 1 year follow-up, 3 were lost at 2 years, 2 lost at 3 years. |
Di 2016 [24] | Hypertension, hyperlipidemia | 0 | 74.2% (49/66) at 1-year; 57.6% (38/66) at 3-year | 0 | BMI, FPG, 2 hPG, HbA1C, FCP, FINS, HOMA-IR | No state | All completed 3 years follow-up |
Gong 2016 [25] | Hypertriglyceridemia, Hypertension, Retinopathy Peripheral neuropathy | 0 | 93.5% (29/31) at 6-month | 0 | BMI, FPG, HbA1c, CP, FINS, GLP-1 | No severe complications | All completed at 1, 3 and 6 months follow-up |
Kular 2016 [26] | No state | 0 | 1, 2, 5 and 7 years were 81.8% (18/22), 78.9% (30/38),70.3% (57/81) and 68.5% (74/108) | 0 | BMI, waist, HbA1c, EWL, mean weight | excessive postoperative suture line bleeding with shock, anastomotic ulceration, anemia, low albumin, bile reflux, excess weight loss | Only 16%(128) of patients lost to follow0up after 7 years |
Li 2016 [27] | No state | 0 | 59.6% (34/57) at 1-year | 0 | FPG, 2hPBG, HbA1C, BMI, 1 h C-P | one early hemorrhage | All at 1 year follow-up |
Yang 2015 [28] | Hypertension | 0 | SG/RYGB: 78.6% (22/32)/ 85.2% (23/32) at 3-year | 0 | HbA1c, FBG, CP, BMI | Two gastroesophageal reflux, a anemia | 55 patient completed 3 years follow-up |
Yi 2015 [29] | No state | 0 | LRYGB/LRYGBS: 30% (9/30)/47% (14/30) | 0 | BMI, HOMA-IR, HbA1c, FPG, FCP, 2hCP | 10 marginal ulcers, two gastrointestinal hemorrhage | All at 1 year follow-up |
Kim 2014 [30] | No state | 0 | 53%, 63%, 90% at 1, 2 and 3 year | 1a | BMI, HbA1c, Fasting glucose, 2 h glucose, CP, Insulin, HOMA-IR | Postoperative bleeding, outflow stasis, infected fluid collection, leakage | 144 at 1 year; 116 at 2 year, 51 at 3 year |
Shrestha 2013 [31] | No state | 0 | A significant decrease in the levels of FPG, 2 h PG, HbA1c, and TG | 0 | BMI, HbA1c, FPG, 2hPG, FINS, HOMA-IR | No state | All at 3 month follow-up |
Lakdawala 2013 [32] | Hypertension, dyslipidemia, hyperuricemia, gastroesophageal reflux disease, sleep apnea, joint pain | 0 | 96.2% (50/52) at 1 year and 5 year | 0 | Average blood glucose, FINS, postprandial serum insulin, FCP, HbA1c | one seromas and one nausea, no major complication | 4d, 1,3,6, months, 1, 2, 3, 4, 5 years |
Wu 2013 [33] | No state | 0 | 75% at 2 months, 83.3% at 4 months | 0 | BMI, FPG, 2hPG, HbA1c | two vomiting and diarrhea, two gastric fistula and infection | All at 2 months, 6 at 4 months. |
Zhu 2012 [34] | Chronic gastritis, fatty liver, hypertension, hypertriglyceridemia, diabetic retinopathy, diabetic nephropathy | 0 | Significant reduction in Glycosylated hemoglobin, diabetes was completely resolved in 9 cases | 0 | BMI, Waist-hip ratio, FPG, 30 m PG, 2 h PG, HbA1C | No major complication | All at 12 months follow-up |
Huang 2011 [35] | Hyperlipidemia, hypertension, steatohepatitis, gouty arthritis | 0 | 90.9% (20/22) at 12 months. | 0 | BMI, Glucose, HbA1, ctriglyceride | No state | All at 12 months follow-up |
Lee 2011 [36] | No state | 0 | 0%,11%, 37%, 53%, 57%, and 55% patients in 1, 4, 12, 26, and 52 weeks and 2 years | 0 | BMI, Glucose, insulin, HbA1c, HOMA, Glucose, Insulin, Insulinogenic index | seven minor complications, no major complication | 62 at 1,4 week, 45 at 12 week, 40 at 26 weeks, 30 at 52 weeks, 20 at 2 years. |
Shah 2010 [37] | Hypertension, dyslipidemia | 0 | 80% (12/15)at 3 months | 0 | BMI, Waist circumference, Fasting blood glucose, HbA1c | No major complication | All at 6, 9 months |
Lee 2008 [38] | 2 comorbidity | 0 | 76.5% (34/44) at 1 year | 0 | BMI, glucose, T-chole, Triglyceride, insulin, CP, HbA1c | No major complication | At 1 year |