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. 2021 Jan 6;7(1):7.
doi: 10.1186/s40792-020-00989-5.

Efficacy of laparoscopic sleeve gastrectomy for patient with morbid obesity and type 1 diabetes mellitus: a case report

Hidetaka Ichikawa  1 , Hirofumi Imoto  2 , Naoki Tanaka  1 , Hiroaki Musha  1 , Shojiro Sawada  3   4 , Takeshi Naitoh  1   5 , Takashi Kamei  1 , Michiaki Unno  1
Affiliations

Efficacy of laparoscopic sleeve gastrectomy for patient with morbid obesity and type 1 diabetes mellitus: a case report

Hidetaka Ichikawa et al. Surg Case Rep. .

Abstract

Background: Bariatric surgery is effective for the treatment of patients with morbid obesity and type 2 diabetes mellitus (T2DM), for body weight loss and glycemic control. However, in Japan, there has been no previous report of the effectiveness bariatric surgery in a case of morbid obesity associated with acute onset type 1 diabetes mellitus (T1DM), in which pancreatic β-cells were destroyed and endogenous insulin was depleted.

Case presentation: A 36-year-old woman with morbid obesity and T1DM, diagnosed when she was 6 years, was admitted for bariatric surgery. At her first consultation, she had a body weight of 106.7 kg and a body mass index of 42.2 kg/m2. Her HbA1c level was 9.0%, with a required daily insulin dose of 75 units. She underwent laparoscopic sleeve gastrectomy. At 1 year after surgery, her body weight had decreased to 81.0 kg and her body mass index to 32.2 kg/m2. In addition, her daily required dose of insulin had decreased to 24 units, with an improvement in her HbA1c level to 7.7%.

Conclusions: Although further evidence needs to be accumulated, including long-term outcomes, laparoscopic sleeve gastrectomy may provide an effective treatment for patients with morbid obesity and T1DM for body weight loss, improvement in HbA1c level, and insulin dose reduction.

Keywords: Laparoscopic sleeve gastrectomy; Metabolic surgery; Morbid obesity; Type 1 diabetes mellitus.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Computed tomography images. a Overall image before surgery, showing b a preoperative visceral fat area of 162.6 cm2 and subcutaneous fat area of 527.9 cm2. c Overall image, 1-year after the surgical procedure, showing a decrease in d the visceral fat area to 44.8 cm2 and the subcutaneous fat area to 408.8 cm2
Fig. 2
Fig. 2
Surgical schema and gastric tube. a Schema of skin incisions (red lines), with the layout and size of ports shown. b Surgical schema, showing a drain placed below the left diaphragm. c Intraoperative photograph, with the complete gastric tube shown
Fig. 3
Fig. 3
Postoperative changes. The change, from preoperative to 12 months postoperatively, in a body weight, body mass index (BMI); b skeletal muscle mass and body fat mass; c HbA1c; and d insulin dose/day. At 1-year after the procedure, the patient’s body weight had decreased to 81 kg and her BMI to 32.2 kg/m2, mainly due to a decrease in body fat mass, with the skeletal muscle mass being maintained. The HbA1c level improved to 7.7%, and the daily insulin dose required reduced to 24 units
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