Table 2 The characteristic of clinical study on laparoscopic metabolic surgery for T2DM with BMI < 35 kg/m² in Asia

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