关键词: 2型糖尿病, 体重指数, 代谢手术, 胰岛素抵抗, 胃袖状切除术, 胃旁路术

Abstract: Controversies and consideration on metabolic surgery for type 2 diabetes with low body mass index        ZHU Li-yong，JI Guang-nian，ZHU Shai-hong. Department of Bariatric and Metabolic Surgery，the Third Xiangya Hospital，Central South University，Changsha 410013，China
Corresponding author：ZHU Shai-hong，E-mail：shzhu@csu.edu.cn
Abstract    Type 2 diabetes is a global health concern. The rise of metabolic surgery provides a new treatment option for type 2 diabetes，which is supported by most of the world's major academic organizations in medicine and surgery. It is controversial whether body mass index (BMI) is used as the sole surgical indication for patients in the Asia-pacific region，especially in Chinese patients who usually has a lower BMI than Caucasian. The authors analyzed the classification of BMI，drug therapy，surgical treatment and the choice of different surgical procedrues，then concluded that for low BMI T2DM patients more attentions should be paid, including the comprehensive evaluation of the patient's age，duration of diabetes，BMI，insulin resistance and pancreatic islet cell function. Sleeve gastrectomy is acceptable in patients with insulin resistance. Roux-en-Y gastric bypass is recommended for patients with impaired islet secretory function. It should be noted that many studies have demonstrated that surgery for T2DM with low BMI is safe and effective so far, meaning it is feasible. However,  a large number of clinical evidence and multi-center clinical studies are still needed to provide high level evidence on the effectiveness of surgical treatment for low BMI T2DM patients.

Key words: type 2 diabetes mellitus, body mass index（BMI）, metabolic surgery, insulin resistance, sleeve gastrectomy, Roux-en-Y gastric bypass