title: Metabolic Surgery for Type 2 Diabetes in Patients with a BMI of <35 kg/m(2): A Surgeon's Perspective.
abstract: Bariatric surgery was developed with the aim of weight reduction. Success was defined only by excess weight loss. Other indices of resolution of metabolic comorbidities were reported, but were mostly secondary. Several communications have reported that regardless of body mass index (BMI), complete or partial remission of type 2 diabetes mellitus (T2DM) is possible. These results mostly occur before weight loss, positioning metabolic surgery as a good tool for controlling the current T2DM epidemic. Medical treatment is evolving, but is expensive and not risk-free. Surgery aimed mainly at diseases such as diabetes and not weight loss are referred to as "metabolic surgery." Metabolic surgery has been proven to be safe and effective, and although more data are needed, it is unquestionable that a new discipline has been founded. Metabolic surgery can effectively treat T2DM in individuals with any BMI, including that below 35 kg/m(2).
authors.affiliation: The Center of Excellence for Metabolic and Bariatric Surgery, Hospital Oswaldo Cruz, São Paulo, Brazil. ricardo.cohen@haoc.com.br
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cohen
authors.forename: Pedro Paulo
authors.initials: PP
authors.lastname: Caravatto
authors.forename: Tarissa
authors.initials: T
authors.lastname: Petry
mesh_terms: D050110:Bariatric Surgery / Q000379:methods; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D001938:Brazil; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000601:surgery*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000378:metabolism / Q000601:surgery*; D018579:Patient Selection; D012074:Remission Induction / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
references.citation: JAMA. 2008 Jan 23;299(3):316-23
references.pmid: 18212316
references.citation: Diabetes Care. 2011 Mar;34(3):763-70
references.pmid: 21357363
references.citation: Ann Surg. 2004 Jan;239(1):1-11
references.pmid: 14685093
references.citation: Gastroenterology. 2010 Jun;138(7):2437-46, 2446.e1
references.pmid: 20226188
references.citation: Ann Surg. 2011 Apr;253(4):699-703
references.pmid: 21475009
references.citation: J Natl Cancer Inst. 2012 Sep 19;104(18):1411-21
references.pmid: 22878886
references.citation: BMJ. 2009 Sep 29;339:b3957
references.pmid: 19808816
references.citation: Ann Surg. 2004 Sep;240(3):416-23; discussion 423-4
references.pmid: 15319713
references.citation: N Engl J Med. 2012 Oct 4;367(14):1332-40
references.pmid: 23034021
references.citation: Endocr Pract. 2011 May-Jun;17(3):334-6
references.pmid: 21700560
references.citation: Arch Surg. 2011 Feb;146(2):143-8
references.pmid: 21339423
references.citation: Diabetes Care. 2013 Jan;36 Suppl 1:S11-66
references.pmid: 23264422
references.citation: Am J Clin Nutr. 2001 Nov;74(5):579-84
references.pmid: 11684524
references.citation: JAMA. 2008 Jan 23;299(3):341-3
references.pmid: 18212321
references.citation: Diabetes Res Clin Pract. 2012 Oct;98(1):159-63
references.pmid: 22705039
references.citation: J Med Toxicol. 2013 Mar;9(1):61-6
references.pmid: 23233435
references.citation: Diabetes Care. 2010 Apr;33(4):695-700
references.pmid: 20056950
references.citation: Ann Surg. 2010 Mar;251(3):399-405
references.pmid: 19934752
references.citation: Diabetes Care. 2009 Jan;32(1):193-203
references.pmid: 18945920
references.citation: Arch Intern Med. 2008 Aug 11;168(15):1609-16
references.pmid: 18695074
references.citation: Obes Surg. 2009 Aug;19(8):1077-83
references.pmid: 19475464
references.citation: Obes Surg. 2011 Feb;21(2):231-7
references.pmid: 21086062
references.citation: Diabetes Care. 2012 Jul;35(7):1420-8
references.pmid: 22723580
references.citation: JAMA. 2007 Jul 11;298(2):194-206
references.pmid: 17622601
references.citation: Diabetes Care. 2005 Nov;28(11):2780-6
references.pmid: 16249558
references.citation: Obesity (Silver Spring). 2012 Jun;20(6):1266-72
references.pmid: 22262157
references.citation: N Engl J Med. 2011 Oct 27;365(17):1597-604
references.pmid: 22029981
references.citation: J Clin Endocrinol Metab. 2013 Feb;98(2):483-95
references.pmid: 23293330
references.citation: Ann Pharmacother. 2011 Apr;45(4):e22
references.pmid: 21487080
references.citation: N Engl J Med. 2007 Feb 1;356(5):437-40
references.pmid: 17267901
references.citation: JAMA. 2007 Sep 12;298(10):1189-95
references.pmid: 17848653
references.citation: Ann Surg. 2010 Sep;252(3):559-66; discussion 566-7
references.pmid: 20739857
references.citation: Surg Obes Relat Dis. 2010 Jul-Aug;6(4):332-8
references.pmid: 19846351
references.citation: Am J Physiol Endocrinol Metab. 2011 May;300(5):E923-32
references.pmid: 21304061
references.citation: World J Surg. 2011 Oct;35(10):2238-44
references.pmid: 21744166
references.citation: N Engl J Med. 2005 Jul 21;353(3):249-54
references.pmid: 16034010
references.citation: J Clin Endocrinol Metab. 2008 Jul;93(7):2479-85
references.pmid: 18430778
references.citation: Arch Intern Med. 2010 Jul 26;170(14):1191-1201
references.pmid: 20656674
references.citation: Surg Obes Relat Dis. 2012 Jul-Aug;8(4):375-80
references.pmid: 22410638
references.citation: J Clin Endocrinol Metab. 2008 Nov;93(11 Suppl 1):S89-96
references.pmid: 18987275
references.citation: Obes Surg. 2010 May;20(5):535-40
references.pmid: 20094819
references.citation: Ann Surg. 2010 Dec;252(6):966-71
references.pmid: 21107106
references.citation: Obes Surg. 2011 Jul;21(7):896-901
references.pmid: 21559794
references.citation: Diabetes. 2011 Aug;60(8):2011-7
references.pmid: 21788578
references.citation: Diabetes Care. 2008 Feb;31 Suppl 2:S290-6
references.pmid: 18227499
references.citation: Obes Surg. 2007 Sep;17(9):1150-8
references.pmid: 18074487
references.citation: Surg Obes Relat Dis. 2012 Mar-Apr;8(2):145-50
references.pmid: 21570362
references.citation: JAMA. 2012 Dec 19;308(23):2517-8
references.pmid: 23287825
references.citation: N Engl J Med. 2003 Jan 30;348(5):383-93
references.pmid: 12556541
references.citation: Obes Surg. 2005 Oct;15(9):1258-64
references.pmid: 16259883
references.citation: Diabetes Res Clin Pract. 2008 May;80(2):e4-6
references.pmid: 18314214
references.citation: Nat Rev Endocrinol. 2012 Sep;8(9):544-56
references.pmid: 22525731
references.citation: Arch Intern Med. 2010 Sep 27;170(17):1566-75
references.pmid: 20876408
references.citation: Surg Obes Relat Dis. 2012 Sep-Oct;8(5):e66-8
references.pmid: 21925965
references.citation: Diabetes Obes Metab. 2012 Mar;14(3):262-70
references.pmid: 22051116
references.citation: Int J Obes (Lond). 2010 Mar;34(3):462-71
references.pmid: 20029383
references.citation: Diabetes Metab J. 2012 Oct;36(5):371-8
references.pmid: 23130322
references.citation: N Engl J Med. 2007 Jun 14;356(24):2457-71
references.pmid: 17517853
references.citation: JAMA. 2005 Oct 19;294(15):1960-3
references.pmid: 16234503
references.citation: Surg Obes Relat Dis. 2010 May-Jun;6(3):296-304
references.pmid: 20096647
references.citation: Diabetes Res Clin Pract. 2012 Nov;98(2):271-84
references.pmid: 23010561
references.citation: J Clin Endocrinol Metab. 2013 Feb;98(2):777-84
references.pmid: 23341488
references.citation: N Engl J Med. 2007 Jun 14;356(24):2522-4
references.pmid: 17517854
references.citation: Surg Obes Relat Dis. 2012 Nov-Dec;8(6):671-7
references.pmid: 23058451
references.citation: JAMA. 2012 Dec 19;308(23):2489-96
references.pmid: 23288372
references.citation: N Engl J Med. 2007 Aug 23;357(8):741-52
references.pmid: 17715408
references.citation: Obesity (Silver Spring). 2010 May;18(5):865-71
references.pmid: 20150899
references.citation: Ann Surg. 1995 Sep;222(3):339-50; discussion 350-2
references.pmid: 7677463
references.citation: Curr Atheroscler Rep. 2010 Nov;12(6):432-9
references.pmid: 20652839
references.citation: Obes Surg. 2011 Mar;21(3):283-7
references.pmid: 21153449
references.citation: J Gastrointest Surg. 2008 May;12(5):945-52
references.pmid: 17940829
references.citation: N Engl J Med. 2004 Dec 23;351(26):2683-93
references.pmid: 15616203
references.citation: Surg Obes Relat Dis. 2006 Sep-Oct;2(5):497-503; discussion 503
references.pmid: 17015199
references.citation: J Clin Endocrinol Metab. 2007 Dec;92(12):4678-85
references.pmid: 17895322
references.citation: Diabetes Metab Syndr. 2012 Jul-Sep;6(3):125-31
references.pmid: 23158974
references.citation: Ann Surg. 2012 Jul;256(1):72-8
references.pmid: 22664560
references.citation: JAMA. 2012 Jan 4;307(1):56-65
references.pmid: 22215166
references.citation: Diabetes Obes Metab. 2010 Aug;12(8):716-21
references.pmid: 20590749
references.citation: Pol Przegl Chir. 2011 Feb;83(2):81-6
references.pmid: 22166285
references.citation: Obes Surg. 2009 Jan;19(1):96-104
references.pmid: 18989728
references.citation: Diabetologia. 2009 Jun;52(6):1027-30
references.pmid: 19308351
references.citation: Obes Surg. 2011 Sep;21(9):1458-68
references.pmid: 21455833
references.citation: Ann Surg. 2006 Nov;244(5):741-9
references.pmid: 17060767
references.citation: N Engl J Med. 2010 Mar 4;362(9):774-7
references.pmid: 20164475
references.citation: Surg Obes Relat Dis. 2009 Jan-Feb;5(1):18-9
references.pmid: 19161933
references.citation: Surg Obes Relat Dis. 2010 Jul-Aug;6(4):347-55
references.pmid: 20176512
references.citation: Endocrine. 2011 Oct;40(2):151-61
references.pmid: 21842289
references.citation: Diabetes Care. 2011 Jun;34(6):1369-71
references.pmid: 21515844
references.citation: JAMA. 2004 Oct 13;292(14):1724-37
references.pmid: 15479938
references.citation: J Clin Endocrinol Metab. 2010 Apr;95(4):1851-5
references.pmid: 20133462
references.citation: Gastroenterology. 2011 Jul;141(1):150-6
references.pmid: 21334333
references.citation: Arch Intern Med. 2003 Nov 24;163(21):2594-602
references.pmid: 14638559
references.citation: Annu Rev Med. 2010;61:393-411
references.pmid: 20059345
references.citation: Surg Endosc. 2008 Mar;22(3):706-16
references.pmid: 17704886
references.citation: JAMA. 2012 Sep 19;308(11):1142-9
references.pmid: 22990273
references.citation: Obes Surg. 2005 Apr;15(4):474-81
references.pmid: 15946424
references.citation: Diabetes Care. 2011 Apr;34(4):923-9
references.pmid: 21447664
references.citation: Lancet. 2009 Jun 20;373(9681):2125-35
references.pmid: 19501900
references.citation: Diabetes Obes Metab. 2009 Feb;11(2):167-76
references.pmid: 19125778
references.citation: Diabet Med. 2011 Jun;28(6):628-42
references.pmid: 21480973
references.citation: Nat Med. 2012 Jun;18(6):950-5
references.pmid: 22610279
references.citation: Diabetes Care. 2012 Dec;35(12):2613-7
references.pmid: 22855732
references.citation: Diabetes Ther. 2012 Nov;3(1):1-8
references.pmid: 22373598
references.citation: Rev Hosp Clin Fac Med Sao Paulo. 2003 Sep-Oct;58(5):I-VIII
references.pmid: 16722003
references.citation: Surg Obes Relat Dis. 2007 Mar-Apr;3(2):195-7
references.pmid: 17386401
references.citation: Obes Surg. 2010 Jun;20(6):776-90
references.pmid: 20333558
references.citation: N Engl J Med. 2012 Apr 26;366(17):1567-76
references.pmid: 22449319
references.citation: Rev Diabet Stud. 2007 Fall;4(3):126-33
references.pmid: 18084670
references.citation: Surg Obes Relat Dis. 2009 Jul-Aug;5(4):425-8
references.pmid: 18996758
references.citation: N Engl J Med. 2005 Jul 21;353(3):300-2
references.pmid: 16034017
references.citation: Ann Intern Med. 2007 Oct 16;147(8):578-81
references.pmid: 17679700
references.citation: Curr Opin Clin Nutr Metab Care. 2006 Jul;9(4):497-507
references.pmid: 16778583
references.citation: Diabetes Care. 2012 Dec;35(12):2580-7
references.pmid: 22923664
references.citation: PLoS Med. 2009 Sep;6(9):e1000154
references.pmid: 19787025
references.citation: Diabetes Care. 2011 May;34 Suppl 2:S202-9
references.pmid: 21525456
references.citation: N Engl J Med. 2008 Feb 7;358(6):580-91
references.pmid: 18256393
references.citation: Diabet Med. 2013 Mar;30(3):345-8
references.pmid: 22998241
references.citation: Obes Surg. 2013 Jan;23(1):93-102
references.pmid: 23161525
references.citation: Indian J Endocrinol Metab. 2012 Jul;16(4):589-98
references.pmid: 22837922
references.citation: Diabetes Care. 2005 Feb;28(2):337-442
references.pmid: 15677789
references.citation: Proc Natl Acad Sci U S A. 2009 Sep 8;106(36):15430-5
references.pmid: 19706383
references.citation: Metabolism. 2005 Sep;54(9):1236-42
references.pmid: 16125536
references.citation: Surg Obes Relat Dis. 2006 May-Jun;2(3):401-4, discussion 404
references.pmid: 16925363
references.citation: Diabetes Technol Ther. 2009 Dec;11(12):785-9
references.pmid: 20001679
references.citation: Br J Clin Pharmacol. 2013 Jan;75(1):254-9
references.pmid: 22574756
references.citation: Surg Obes Relat Dis. 2006 Jul-Aug;2(4):464-7
references.pmid: 16925382
references.citation: J Clin Endocrinol Metab. 2013 Feb;98(2):E279-82
references.pmid: 23337729
references.citation: Arch Med Sci. 2012 Nov 9;8(5):907-17
references.pmid: 23185203
references.citation: Lancet. 2011 Jul 9;378(9786):108-10
references.pmid: 21742162
references.citation: Surgery. 2010 May;147(5):664-9
references.pmid: 20004451
references.citation: Zhonghua Yi Xue Za Zhi. 2009 Nov 3;89(40):2858-61
references.pmid: 20137669
references.citation: Diabetes Care. 2010 Jul;33(7):1438-42
references.pmid: 20368410
references.citation: Obes Surg. 2009 Mar;19(3):307-12
references.pmid: 18987919
references.citation: Ann Surg. 2003 Oct;238(4):467-84; discussion 84-5
references.pmid: 14530719
references.citation: N Engl J Med. 2012 Apr 26;366(17):1577-85
references.pmid: 22449317