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. 2015 Jul-Aug;11(4):798-805.
doi: 10.1016/j.soard.2014.12.016. Epub 2014 Dec 24.

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

Maud Robert  1 , Pascale Belanger  2 , Frédéric Simon Hould  3 , Simon Marceau  3 , André Tchernof  4 , Laurent Biertho  3
Affiliations

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

Maud Robert et al. Surg Obes Relat Dis. 2015 Jul-Aug.

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.

Keywords: Biliopancreatic diversion; Glycemic control; Insulin requirements; Metabolic surgery; Obesity; Sleeve gastrectomy; Type 1 diabetes; Weight loss.

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