Outcome of Bariatric Surgery in Patients With Type 1 Diabetes Mellitus: Our Experience and Review of the Literature

Surg Endosc. 2016 Dec;30(12):5428-5433. doi: 10.1007/s00464-016-4901-2. Epub 2016 Apr 28.

Abstract

Background: The beneficial effect of bariatric surgery (BS) in type 2 diabetes mellitus patients is well established. Conversely, little is known about the efficacy of BS in type 1 diabetes mellitus (T1DM) patients, despite the increasing prevalence of obesity in this population.

Methods: A retrospective review was carried out on a prospectively collected bariatric surgery registry of all patients undergoing BS at two university hospitals between 2010 and 2015. Patients with T1DM were identified, and detailed chart reviews were obtained.

Results: In this time period, we operated on thirteen patients with T1DM. Eight were female (61.5 %). Median age at time of surgery was 38 ± 8.3 (range 28-53) years. The procedures performed were laparoscopic sleeve gastrectomy (n = 10) and laparoscopic Roux-en-Y gastric bypass (n = 3). On median postoperative follow-up of 24 (range 2.5-51) months, mean body mass index significantly decreased from 39.9 ± 4.1 to 30.1 ± 3.9 kg/m2 (P < 0.0001) and insulin requirements were significantly reduced from 83.7 ± 40.4 to 45.7 ± 33.1 U/day (P < 0.01). However, there was no significant change in glycemic control assessed by HbA1C (P = 0.2). During the first months following surgery, three patients (21.4 %) experienced diabetic ketoacidosis, and four patients (28.6 %) reported more frequent episodes of hypoglycemia.

Conclusions: Bariatric surgery in morbidly obese T1DM patients is an effective method for weight loss, leading to a remarkable improvement in insulin requirements. Larger prospective studies are still needed to confirm these findings, assess long-term effects of BS and better delineate its risk-to-benefit ratio in this growing population of morbidly obese patients with T1DM.

Keywords: Bariatric surgery; Glycemic control; Insulin requirements; Obesity; T1DM; Weight loss.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Bariatric Surgery* / methods
  • Diabetes Mellitus, Type 1 / complications*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Obesity, Morbid / complications
  • Obesity, Morbid / surgery*
  • Registries
  • Retrospective Studies
  • Treatment Outcome
  • Weight Loss