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Obesity Week 2013

Surgery can improve glycaemic status for type 1 diabetics

There was also favourable change in levels of LDL (p=0.02), HDL (p=0.001), and triglyceride (p=0.007) following surgery

Bariatric surgery leads to a ‘remarkable’ and sustained weight loss in severely obese patients with type 1 diabetes and results in significant improvement in their glycaemic status, according to the results from a small study from Cleveland Clinic.

The study researchers sought to evaluate the metabolic outcomes including the glycaemic status of patients with type 1 diabetes after bariatric surgery.

They examined the clinical outcomes and metabolic parameters of ten morbidly obese patients with poorly controlled type 1 diabetes who underwent laparoscopic bariatric surgery. The diagnosis of type 1 diabetes was verified for all patients by the presence of pancreatic auto-antibodies (islet cell, and glutamic acid decarboxylase), absence of c-peptide, and/or documented history of diabetic ketoacidosis (DKA).

Baseline characteristics, intraoperative data, and postoperative outcomes including changes in weight, glycated haemoglobin (A1C), daily insulin requirements, lipid panel, and blood pressure were assessed. A paired t-test was used to analyse changes at the last follow-up point from baseline.

Patients had a male-to-female to ratio of 1:9, a mean age of 45.6±10.9 years, a mean baseline BMI of 41.6±3.8, a median duration of type 1 diabetes of 22 (range, 2-43) years, and a median of ten (range, 5-13) obesity- or type 1 diabetes 1-related comorbidities.

One patient had a history of coronary bypass and one had a history of failed kidney-pancreas transplant. Bariatric procedures included laparoscopic Roux-en-Y gastric bypass (n=7), adjustable gastric banding ( n=2), and sleeve gastrectomy (n=1).

There was no intraoperative complication and no need for conversion to laparotomy. In total, there were five postoperative complications occurred including DKA on postoperative day ten, DVT, ulcer at gastrojejunal anastomosis, oesophageal dysmotility, and persistent nausea.

At a mean follow up of 36.0±32.6 months, excess weight loss >50% was achieved in all patients except one case of adjustable gastric banding. The mean reduction in BMI of 26.6±9.4% was associated with a significant mean reduction in A1C (9.9±1.5 vs. 8.8±0.8 percent, p=0.02) and daily insulin requirement (0.74±0.32 vs. 0.40±0.15 U/kg, p=0.004).

There was also favourable change in levels of LDL (p=0.02), HDL (p=0.001), and triglyceride (p=0.007) following surgery, and hypertension resolved or improved in five of seven (71%) hypertensive patients. Albuminuria resolved in one of two patients with preoperative microalbuminuria.

“The favourable metabolic effects of bariatric surgery may facilitate medical management of type 1 diabetes,” they concluded. “The true role of bariatric surgery in type 1 diabetes awaits larger studies.”

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American Society for Metabolic and Bariatric Surgery

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