Impact of bariatric surgery in patients with obesity and type 1 diabetes mellitus

Authors

  • Paola Polo Endocrinology Service, Las Lomas Sanatorium, Province of Buenos Aires, Argentina
  • María Graciela Álvarez Center for the Study and Treatment of Severe Obesity (CETOS), Autonomous City of Buenos Aires, Argentina
  • Eduardo Babor Center for the Study and Treatment of Severe Obesity (CETOS), Autonomous City of Buenos Aires, Argentina
  • Maia Herrero Sanatorium of Salvador, Córdoba, Argentina
  • Sandra González IMA Clinic, Adrogué, Province of Buenos Aires, Argentina
  • María Yuma Italian Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina
  • Isaac Sinay Cardiovascular Institute of Buenos Aires, Autonomous City of Buenos Aires, Argentina
  • León Litwak Italian Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina
  • Susana Gutt Italian Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina
  • Susana Fuentes Argentine Diabetes Society, Autonomous City of Buenos Aires, Argentina
  • Carla Musso Favaloro Foundation, Autonomous City of Buenos Aires, Argentina
  • Marianela Aguirre Ackermann Comprehensive Center of Endocrinology and Nutrition (CIEN), Corrientes, Argentina

DOI:

https://doi.org/10.47196/diab.v53i3Sup.170

Keywords:

diabetes mellitus type 1, obesity, bariatric surgery

Abstract

Introduction: obesity is a serious growing medical problem in type 1 diabetes mellitus (DM1). Insulin replacement is the only available therapy for these patients with DM1 and the main problems associated with it are hypoglycemia and weight gain. Bariatric surgery (BS) showed improvement in glycemic control in type 2 but only few cases of DM1 have been reported.

Objectives: to evaluate changes in metabolic parameters in obese DM1 patients who underwent BS.

Materials and methods: retrospectively, the clinical histories of seven patients with DM1 and obesity who were treated with CB were evaluated. The Wilcoxon test was used for paired samples in order to assess the difference between the pre-surgery data and one year after it.

Results: seven patients DM1 were evaluated. The median age was 48 years (IQR 45 to 49). The median body mass index at baseline and at follow-up were 39.6 Kg/m (IQR 35 to 42) and 24.9 Kg/m2 (IQR 24.7 to 29.5) respectively. The median glycated hemoglobin at baseline and at follow-up were 9.3% (IQR 8.3 to 10.5) and 7.2% (IQR 6.7 to 8.8) respectively. The median insulin requirements before and after BS were 110 UI (IQR 70 a 120) and 24 UI (IQR 16 a 30). All differences were statistically significant (p value<0.05).

Conclusions: our findings encourage considering BS as a tool in type 1 obese diabetic patients in terms to improve management of glycemic control and body weight.

Author Biographies

Paola Polo, Endocrinology Service, Las Lomas Sanatorium, Province of Buenos Aires, Argentina

Endocrinologist

María Graciela Álvarez, Center for the Study and Treatment of Severe Obesity (CETOS), Autonomous City of Buenos Aires, Argentina

Medical specialist in Internal Medicine and Nutrition; Team Coordinator of the Center for Study and Treatment of Severe Obesity (CETOS)

Eduardo Babor, Center for the Study and Treatment of Severe Obesity (CETOS), Autonomous City of Buenos Aires, Argentina

Surgeon specializing in Laparoscopic and Bariatric Surgery, Center for Study and Treatment of Severe Obesity (CETOS)

Maia Herrero, Sanatorium of Salvador, Córdoba, Argentina

Endocrinologist, Sanatorio del Salvador, Marcheggiani Medical Center and Dr. Ángel Ferreyra Hospital

Sandra González, IMA Clinic, Adrogué, Province of Buenos Aires, Argentina

Medical Clinic specialized in Diabetes

María Yuma, Italian Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina

Medical specialist in Nutrition

Isaac Sinay, Cardiovascular Institute of Buenos Aires, Autonomous City of Buenos Aires, Argentina

Endocrinologist; Consultant of the Cardiovascular Institute of Buenos Aires

León Litwak, Italian Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina

Specialist in Endocrinology; Consultant of the Endocrinology Service of the Italian Hospital of Buenos Aires

Susana Gutt, Italian Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina

Medical specialist in Nutrition; Chief of Nutrition, Italian Hospital of Buenos Aires

Susana Fuentes, Argentine Diabetes Society, Autonomous City of Buenos Aires, Argentina

Medical specialist in Internal Medicine and Diabetes; Coordinator of the Obesity Committee of the Argentine Diabetes Society

Carla Musso, Favaloro Foundation, Autonomous City of Buenos Aires, Argentina

Endocrinologist; Diabetes Coordinator

Marianela Aguirre Ackermann, Comprehensive Center of Endocrinology and Nutrition (CIEN), Corrientes, Argentina

Medical specialist in Internal Medicine and Nutrition; Coordinator of Nutrition and Diabetes of the Integral Center of Endocrinology and Nutrition (CIEN)

References

Chillarón JJ, Flores Le-Roux JA, Benaiges D, Pedro-Botet J. Type 1 diabetes, metabolic syndrome and cardiovascular risk. Metabolism 2014; 63:181-187.

DCCT Reserch Group. The absence of a glycemic threshold for the development of long-term complications: the perspective of the Diabetes Control and Complications Trial. Diabetes 1996; 45:1289-1298.

Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009; 122 (3): 248-56.

Sibley SD, Palmer JP, Hirsch IB, Brunzell. Visceral obesity, hepatic lipase activity and dyslipidemia in type 1 diabetes. J Clin Endocrinol Metab 2003 Jul; 88(7).

Franck M, Paquot N, Scheen AJ. Influence of body weight on the natural history of and the therapeutic approaches to type 1 diabetes. Rev Med Liege 2012; 67:461-467.

Cohen R. Comment on: should metabolic surgery be offered in morbidly obese patients with type I diabetes? Surg Obes Relat Dis 2015; 11:805-807

Price SA, Gorelik A, Fourlanos S, Colman PG, Wentworth JM. Obesity is associated with retinopathy and macrovascular disease in type 1 diabetes. Obes Res Clin Pract 2014; 8:e178-e182.

De Block CE, De Leeuw IH, Van Gaal LF. Impact of overweight on chronic microvascular complications in type 1 diabetic patients. Diabetes Care 2005; 28:1649-1655

Czupryniac L, Wiszniewski M, Szymansky D. Long term results of gastric bypass surgery in morbidly obese type 1 diabetes patients. Obes Surg 2010; 20:506-8.

Mendez CE, Tanenberg RJ, Pories W. Outcomes of Roux en Y gastric bypass surgery for severely obese patients with type 1 diabetes: a case series report. Diabetes Metab Syndr Obes 2010; 3:281-283.

Brethauer S, Aminian A, Rosental R. Bariatric surgery improves the metabolic profile of morbidly obese patients with type 1 diabetes. Diabetes Care 2014; 37: e51-e52.

Lannoo M, Dillemans B, Van Nieuwenhove Y. Bariatric surgery induces weight loss but does not improve glycemic control in patients with type 1 diabetes. Diabetes Care 2014; 37: e173-e174.

Kirwan JP, Aminian A, Kashyap S. Bariatric surgery in obese patients with type 1 diabetes. Diabetes Care 2016; 39:941-948.

Landau Z, Kowen-Sandbank G, Jakubowicz D. Bariatric surgery in patients with type 1 diabetes: special considerations are warranted. Ther Adv Endocrinol Metab 2019; Vol. 10: 1-8.

Vilarrasa N, Rubio MA, Miñambres I. Long-term outcomes in patients with morbid obesity and type 1 diabetes undergoing bariatric surgery. Obesity Surgery 2017 Apr; 27(4):856-863.

Published

2023-01-10

How to Cite

Polo, P., Álvarez, M. G., Babor, E., Herrero, M., González, S., Yuma, M., Sinay, I., Litwak, L., Gutt, S., Fuentes, S., Musso, C., & Aguirre Ackermann, M. (2023). Impact of bariatric surgery in patients with obesity and type 1 diabetes mellitus. Journal of the Argentine Society of Diabetes, 53(3Sup), 139–142. https://doi.org/10.47196/diab.v53i3Sup.170

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