Choice of Bariatric Surgery in Patients with Obesity and Type 1 Diabetes Mellitus? an Up-to-Date Systematic Review

Chetan Parmar, Simone Appel, Lyndcie Lee, Rui Ribeiro, Nasser Sakran, Sjaak Pouwels

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: The prevalence of obesity in patients with type 1 diabetes mellitus (T1DM) has been increasing. Metabolic bariatric surgery (MBS) has proven to be effective in treating patients with T2DM. However, evidence for the benefit of the procedure for patients with T1DM is still limited, particularly in terms of glycemic control, demonstrating the need for a systematic review investigating this. Method: A systematic review was performed in accordance with the PRISMA guidelines. Outcome measures such as weight loss, remission of comorbidities, pre- and post-intervention insulin requirements, and HbA1c levels were extracted. Results: Thirty studies were included with a total of 706 patients (F = 524, M = 74, N/A = 60). The mean age was 40.01 years. The mean weight and body mass index (BMI) were 112.76 kg and 40.88 kg/m2 (24–58.9) respectively. The common procedure performed was RYGB (n = 497 (70.4%)), followed by SG (n = 131 (18.6%)). The mean decrease of insulin requirements was 92.3 IU/day (36.2–174) preoperatively to a mean of 35.8 IU/day (5–75) post-operatively. No significant trend was found for changes in HbA1c levels. The main side effects were episodes of hypoglycemia and diabetic ketoacidosis (DKA); there was no mortality. The mean %EWL was 74.57% (60–90.5%) at ≥ 6 follow-up months. Reductions in comorbidities such as hypertension and cardiovascular disease (CVD) were recorded in multiple studies. Conclusion: Patients with obesity and T1DM can expect significant weight loss, potential resolution of comorbidities, and reduction of insulin requirements, but it does not usually result in improved glycemic control. Based on current review, best choice of bariatric surgery in such patients cannot yet be established. Graphical abstract: [Figure not available: see fulltext.]

Original languageEnglish
Pages (from-to)3992-4006
Number of pages15
JournalObesity Surgery
Volume32
Issue number12
DOIs
StatePublished - Dec 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Keywords

  • Bariatric surgery
  • Metabolic surgery
  • Obesity
  • Type 1 diabetes

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