Bariatric surgery is an effective treatment of
type 2 diabetes in obese patients. The
obesity epidemic does not spare patients with
type 1 diabetes mellitus (T1DM), but there is no consensus regarding the role of surgery in the management of obese T1DM patients. Published data consistently report significant
weight loss after surgery in obese T1DM patients, but long-term glycaemic control remains difficult to achieve. Here we present our experience with a challenging patient and a review of the literature. Our patient successfully underwent a
roux-en-Y gastric bypass (RYGB) when she was 28 years old. Five years after surgery, she was diagnosed with
latent autoimmune diabetes of adults and
insulin therapy was initiated.
Insulin therapy proved very difficult to adjust, with frequent episodes of postprandial hyperglycaemia. These difficulties could only be overcome by the initiation of a subcutaneous
insulin infusion using a sensor-augmented
insulin pump with automated
suspension. This change allowed better glycaemic control. Despite considerable
weight loss with a concomitant decrease in
insulin requirement, glycaemic control remained difficult after surgery. Due to their different impacts on
glucose kinetics, the type of surgical operation should be part of the assessment. These patients might benefit from sensor-augmented
insulin pump
therapy with automated
insulin suspension after
bariatric surgery. The decision for surgical intervention in these patients should be carefully weighed against the difficulties in achieving adequate glycaemic control.