Should metabolic surgery be offered in morbidly obese patients with type I diabetes?

Abstract

BACKGROUND:

Bariatric surgery has recently been endorsed as an effective treatment of type 2 diabetes (T2D) in severely obese patients. Little is known about its metabolic effects in type 1 diabetes (T1D). The objectives were to assess bariatric surgery outcomes in T1D obese patients who underwent either a biliopancreatic diversion (BPD) or a sleeve gastrectomy (SG) and who were matched with T2D obese patients requiring insulin therapy. The study setting was at a university-affiliated tertiary care center.

METHODS:

Through retrospective analysis of prospectively collected data, ten patients with T1D (7 BPD, 3 SG) were matched with 20 patients with T2D (14 BPD, 6 SG) according to age, gender, type of surgery, initial Body Mass Index and insulin requirements (1:2 matching). Weight loss, diabetes control, and remission of co-morbidities were compared.

RESULTS:

Mean follow-up was 55.1 months. Mean Excess BMI Loss% tended to be greater in T1D patients compared to T2D (77.1% versus 68.3%, P = .14). The remission and improvement rates of T2D were 55% and 45% versus 0% and 90% for T1D. The remission rate of T2D was significantly greater after BPD (71.43%) compared to SG (16.67%, P = .04). Insulin requirements were significantly reduced in both groups after surgery (T1D: .44 ±.24 versus 1.09 ±.7 units/kg/d, P = 0.03, T2D: .03 ±.12 versus .89 ±.77 units/kg/d, P = .0001). Remission rates of hypertension and dyslipidemia were similar for T1D and T2D (66.7% versus 62.5%, P = .63 and 88.9% versus 75%, P = .23).

CONCLUSIONS:

Even if metabolic surgery has limited effect on glycemic control in T1D, it improves insulin sensitivity and other co-morbidities. It should be considered as a therapeutic option in selected obese patients with metabolic syndrome and high cardio-vascular risk.

• Authors: Maud Robert, Pascale Belanger, Frédéric Simon Hould, Simon Marceau, André Tchernof, Laurent Biertho
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) 2015 Jul-Aug Vol. 11 Issue 4 Pg. 798-805 ISSN: 1878-7533 [Electronic] United States
• PMID: 25868828 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Chemical References

• Blood Glucose

Topics

• Adult
• Bariatric Surgery (methods)
• Blood Glucose (metabolism)
• Body Mass Index
• Diabetes Mellitus, Type 1 (blood, complications, surgery)
• Female
• Follow-Up Studies
• Humans
• Laparoscopy (methods)
• Male
• Obesity, Morbid (complications, surgery)
• Retrospective Studies
• Treatment Outcome
• Weight Loss