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

摘要： 2型糖尿病为全球性健康问题。代谢手术的兴起为2型糖尿病治疗提供了新的治疗手段，目前得到全球多个重要学术组织的支持。以BMI作为病人选择的首要手术指征，对于平均BMI低于欧美人群的亚太地区尤其中国人群是否同样适用具有争议。从BMI分级、手术治疗与药物治疗、不同术式选择等方面进行综合分析，对于低BMI的T2DM病人，应更注重从病人年龄、糖尿病病程、BMI、胰岛素抵抗状态、胰岛细胞分泌功能进行综合评估：以胰岛素抵抗为主，可选择胃袖状切除术；对于胰岛分泌功能受损者，建议行胃旁路术。诸多研究已证实，手术治疗低BMI的T2DM病人安全、有效，具有可行性，但仍需要大量高级别临床证据、多中心联合进行临床研究，为手术治疗低BMI的T2DM病人提供良好佐证。

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