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Bariatric surgery yielded favorable metabolic effects in obese type 1 diabetes
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Bariatric surgery could lead to significant and consistent weight loss in severely obese patients with type 1 diabetes, according to researchers.
“Only fewer than 10 cases of bariatric surgery in patients with type 1 diabetes have been reported in the literature, which shows a significant weight reduction and improvement in glycemic control,” Stacy A. Brethauer, MD, of the Bariatric and Metabolic Institute at the Cleveland Clinic, and colleagues wrote.
Brethauer and colleagues assessed the clinical outcomes and metabolic parameters of 10 morbidly obese patients (mean BMI, 41.6; mean age, 45.6 years) with poorly controlled type 1 diabetes who also underwent laparoscopic bariatric surgery between 2005 and 2012.
Stacy A. Brethauer
The type of bariatric procedures included laparoscopic Roux-en-Y gastric bypass (n=7), adjustable gastric banding (n=2), and sleeve gastrectomy (n=1).
Five postoperative complications, including diabetic ketoacidosis on postoperative day 10, deep vein thrombosis, ulcers at gastrojejunal anastomosis, esophageal dysmotility and persistent nausea were reported, according to researchers.
Three-year follow-up data indicated an excess weight loss of >60% in all patients excluding one who underwent adjustable gastric banding.
Reduction of mean BMI (from 41.6 to 27) was associated with a significant reduction in HbA1c levels (10% vs. 8.9%; P=.039) and daily insulin requirement (0.74 U/kg daily vs. 0.4 U/kg daily; P=.004), according to data.
Measurements of LDL (–23 mg/dL; P=.02), HDL (10.8 mg/dL; P=.001), and triglycerides (–30.5 mg/dL; P=.007) improved after surgery. Hypertension either resolved or improved in five of seven (71%) patients, according to researchers. Moreover, albuminuria resolved in one of two patients with preoperative microalbuminuria.
The researchers suggest longer follow-up studies in a larger cohort to determine the role of bariatric surgery in patients with type 1 diabetes.
Disclosure: The researchers report no relevant financial disclosures.
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