Skip to main content

Advertisement

Log in

Bariatric Surgery in Type 1 Diabetes Mellitus: A Systematic Review

Obesity Surgery Aims and scope Submit manuscript

Abstract

Bariatric surgery is recognised as an effective treatment strategy for obese patients with type 2 diabetes mellitus. An increasing number of patients with type 1 diabetes mellitus also suffer with obesity and obesity-associated comorbidities but the role of bariatric and metabolic surgery in this group of patients is unclear. This systematic review investigates published English language scientific literature to understand the results of bariatric surgery in obese patients with type 1 diabetes mellitus. We found that these patients can experience significant weight loss and comorbidity resolution with bariatric surgery. Though most patients also see a decline in total insulin requirement, glycaemic control remains difficult. Most of the patients reported in literature have undergone gastric bypass but data is insufficient to recommend any particular procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Abbreviations

T2DM:

type 2 diabetes mellitus

T1DM:

type 1 diabetes mellitus

RYGB:

Roux-en-Y gastric bypass

SG:

sleeve gastrectomy

BPD:

biliopancreatic diversion

LADA:

latent autoimmune diabetes in adults

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

GLP-1:

glucagon-like peptide 1

PYY:

peptide YY

References

  1. Robert M, Belanger P, Hould FS, et al. Should metabolic surgery be offered in morbidly obese patients with type I diabetes? Surg Obes Relat Dis. 2014. doi:10.1016/j.soard.2014.12.016.

    Google Scholar 

  2. Maraka S, Kudva YC, Kellogg TA, et al. Bariatric surgery and diabetes: implications of type 1 versus insulin-requiring type 2. Obesity (Silver Spring). 2015;23(3):552–7.

    Article  CAS  Google Scholar 

  3. Blanco J, Jiménez A, Casamitjana R, et al. Relevance of beta-cell function for improved glycemic control after gastric bypass surgery. Surg Obes Relat Dis. 2014;10(1):9–13. quiz 189–90.

    Article  PubMed  Google Scholar 

  4. Chillarón JJ, Benaiges D, Mañé L, et al. Obesity and type 1 diabetes mellitus management. Minerva Endocrinol. 2015;40(1):53–60.

    PubMed  Google Scholar 

  5. Polsky S, Ellis SL. Obesity, insulin resistance, and type 1 diabetes mellitus. Curr Opin Endocrinol Diabetes Obes. 2015;22(4):277–82.

    Article  PubMed  CAS  Google Scholar 

  6. Price SA, Gorelik A, Fourlanos S, et al. Obesity is associated with retinopathy and macrovascular disease in type 1 diabetes. Obes Res Clin Pract. 2014;8(2):e178–82.

    Article  PubMed  Google Scholar 

  7. http://www.niddk.nih.gov/health-information/health-topics/Diabetes/causes-diabetes/Pages/index.aspx Last accessed on 25th June 2015

  8. Komaroff AL. Ask the doctor. I’ve heard bariatric surgery can reduce type 2 diabetes. How about type 1? Harv Health Lett. 2012;38(2):2.

    Google Scholar 

  9. Deitel M. Update: why diabetes does not resolve in some patients after bariatric surgery. Obes Surg. 2011;21(6):794–6.

    Article  PubMed  Google Scholar 

  10. Czupryniak L, Strzelczyk J, Cypryk K, et al. Gastric bypass surgery in severely obese type 1 diabetic patients. Diabetes Care. 2004;27(10):2561–2.

    Article  PubMed  Google Scholar 

  11. Czupryniak L, Wiszniewski M, Szymański D, et al. Long-term results of gastric bypass surgery in morbidly obese type 1 diabetes patients. Obes Surg. 2010;20(4):506–8.

    Article  PubMed  Google Scholar 

  12. Middelbeek RJ, James-Todd T, Patti ME, et al. Short-term insulin requirements following gastric bypass surgery in severely obese women with type 1 diabetes. Obes Surg. 2014;24(9):1442–6.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Middelbeek RJ, James-Todd T, Cavallerano JD, et al. Gastric bypass surgery in severely obese women with type 1 diabetes: anthropometric and cardiometabolic effects at 1 and 5 years postsurgery. Diabetes Care. 2015;38(7):e104–5.

    Article  PubMed  Google Scholar 

  14. Sarruf DA, Bonner-Weir S, Schwartz MW. New clues to bariatric surgery’s benefits. Nat Med. 2012;18(6):860–1.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  15. Breen DM, Rasmussen BA, Kokorovic A, et al. Jejunal nutrient sensing is required for duodenal-jejunal bypass surgery to rapidly lower glucose concentrations in uncontrolled diabetes. Nat Med. 2012;18(6):950–5.

    Article  PubMed  CAS  Google Scholar 

  16. Cossu ML, Noya G, Tonolo GC, et al. Duodenal switch without gastric resection: results and observations after 6 years. Obes Surg. 2004;14(10):1354–9.

    Article  PubMed  Google Scholar 

  17. Chuang J, Zeller MH, Inge T, et al. Bariatric surgery for severe obesity in two adolescents with type 1 diabetes. Pediatrics. 2013;132(4):e1031–4.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Serban V, Brink S, Timar B, et al. An increasing incidence of type 1 diabetes mellitus in Romanian children aged 0 to 17 years. J Pediatr Endocrinol Metab. 2015;28(3–4):293–8.

    PubMed  Google Scholar 

  19. Derraik JG, Reed PW, Jefferies C, et al. Increasing incidence and age at diagnosis among children with type 1 diabetes mellitus over a 20-year period in Auckland (New Zealand). PLoS One. 2012;7(2), e32640.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  20. Evertsen J, Alemzadeh R, Wang X. Increasing incidence of pediatric type 1 diabetes mellitus in Southeastern Wisconsin: relationship with body weight at diagnosis. PLoS One. 2009;4(9), e6873.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Newhook LA, Grant M, Sloka S, et al. Very high and increasing incidence of type 1 diabetes mellitus in Newfoundland and Labrador. Canada Pediatr Diabetes. 2008;9(3 Pt 2):62–8.

    Article  PubMed  CAS  Google Scholar 

  22. Hussain A, Mahmood H, El-Hasani S. Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus? Can J Surg. 2009;52(6):E269–75.

    PubMed  PubMed Central  Google Scholar 

  23. Chillarón JJ, Sales MP, Flores-Le-Roux JA, et al. Insulin resistance and hypertension in patients with type 1 diabetes. J Diabetes Complications. 2011;25(4):232–6.

    Article  PubMed  Google Scholar 

  24. Chillaron JJ, Flores Le-Roux JA, Benaiges D, et al. Type 1 diabetes, metabolic syndrome and cardiovascular risk. Metabolism. 2014;63(2):181–7.

    Article  PubMed  CAS  Google Scholar 

  25. Batsis JA, Sarr MG, Collazo-Clavell ML, et al. Cardiovascular risk after bariatric surgery for obesity. Am J Cardiol. 2008;102(7):930–7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Shuai X, Tao K, Mori M, et al. Bariatric surgery for metabolic syndrome in obesity. Metab Syndr Relat Disord. 2015;13(4):149–60.

    Article  PubMed  Google Scholar 

  27. Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54(10):2506–14.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  28. Raab H, Weiner RA, Frenken M, et al. Obesity and metabolic surgery in type 1 diabetes mellitus. Nutr Hosp. 2013;28 Suppl 2:31–4.

    PubMed  CAS  Google Scholar 

  29. Manning SB, Pucci A, Batterham RL, et al. Latent autoimmune diabetes in adults presenting as diabetes “recurrence” after bariatric surgery: a case report. Diabetes Care. 2013;36(8), e120.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pozzilli P, Guglielmi C, Pronina E, et al. Double or hybrid diabetes associated with an increase in type 1 and type 2 diabetes in children and youths. Pediatr Diabetes. 2007;8 Suppl 9:88–95.

    Article  PubMed  Google Scholar 

  31. Pozzilli P, Guglielmi C, Caprio S, et al. Obesity, autoimmunity, and double diabetes in youth. Diabetes Care. 2011;34 Suppl 2:S166–70.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Dirksen C, Jacobsen SH, Bojsen-Møller KN, et al. Reduction in cardiovascular risk factors and insulin dose, but no beta-cell regeneration 1 year after Roux-en-Y gastric bypass in an obese patient with type 1 diabetes: a case report. Obes Res Clin Pract. 2013;7(4):e269–74.

    Article  PubMed  Google Scholar 

  33. Farilla L, Bulotta A, Hirshberg B, et al. Glucagon-like peptide 1 inhibits cell apoptosis and improves glucose responsiveness of freshly isolated human islets. Endocrinology. 2003;144(12):5149–58.

    Article  PubMed  CAS  Google Scholar 

  34. Farilla L, Hui H, Bertolotto C, et al. Glucagon-like peptide-1 promotes islet cell growth and inhibits apoptosis in Zucker diabetic rats. Endocrinology. 2002;143(11):4397–408.

    Article  PubMed  CAS  Google Scholar 

  35. Meier JJ, Bhushan A, Butler AE, et al. Sustained beta cell apoptosis in patients with long-standing type 1 diabetes: indirect evidence for islet regeneration? Diabetologia. 2005;48(11):2221–8.

    Article  PubMed  CAS  Google Scholar 

  36. Hari Kumar KV, Shaikh A, Prusty P. Addition of exenatide or sitagliptin to insulin in new onset type 1 diabetes: a randomized, open label study. Diabetes Res Clin Pract. 2013;100(2):e55–8.

    Article  PubMed  CAS  Google Scholar 

  37. Traina AN, Lull ME, Hui AC, et al. Once-weekly exenatide as adjunct treatment of type 1 diabetes mellitus in patients receiving continuous subcutaneous insulin infusion therapy. Can J Diabetes. 2014;38(4):269–72.

    Article  PubMed  Google Scholar 

  38. Lannoo M, Dillemans B, Van Nieuwenhove Y, et al. Bariatric surgery induces weight loss but does not improve glycemic control in patients with type 1 diabetes. Diabetes Care. 2014;37(8):e173–4.

    Article  PubMed  Google Scholar 

  39. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50. discussion 350–2.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  40. Nambam B, Aggarwal S, Jain A. Latent autoimmune diabetes in adults: a distinct but heterogenous clinical entity. World J Diabetes. 2010;1(4):111–5.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Fourlanos S, Dotta F, Greenbaum CJ, et al. Latent autoimmune diabetes in adults (LADA) should be less latent. Diabetologia. 2005;48(11):2206–12.

    Article  PubMed  CAS  Google Scholar 

  42. Baskota A, Li S, Dhakal N, et al. Bariatric surgery for type 2 diabetes mellitus in patients with BMI <30 kg/m2: a systematic review and meta-analysis. PLoS One. 2015;10(7), e0132335.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Ngiam KY, Lee WJ, Lee YC, et al. Efficacy of metabolic surgery on HbA1c decrease in type 2 diabetes mellitus patients with BMI <3558—a review. Obes Surg. 2014;24(1):148–58.

    Article  PubMed  Google Scholar 

  44. Shimizu H, Timratana P, Schauer PR, et al. Review of metabolic surgery for type 2 diabetes in patients with a BMI <35 kg/m2. J Obes. 2012;2012:147256. doi:10.1155/2012/147256.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Fuertes-Zamorano N, Sánchez-Pernaute A, Torres García AJ, et al. Bariatric surgery in type 1 diabetes mellitus; long-term experience in two cases. Nutr Hosp. 2013;28(4):1333–6.

    PubMed  Google Scholar 

  46. Brethauer SA, Aminian A, Rosenthal RJ, et al. Bariatric surgery improves the metabolic profile of morbidly obese patients with type 1 diabetes. Diabetes Care. 2014;37(3):e51–2.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Reyes Garcia R, Romero Muñoz M, Galbis Verdú H. Bariatric surgery in type 1 diabetes. Endocrinol Nutr. 2013;60(1):46–7.

    Article  PubMed  Google Scholar 

  48. 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;3:281–3.

    PubMed  CAS  PubMed Central  Google Scholar 

  49. Ziemiański P, Lisik W, Marszałek RJ, et al. Improvement of graft function following Roux-en-Y gastric bypass surgery in a morbidly obese kidney recipient: a case report and literature review. Ann Transplant. 2014;19:639–42.

    Article  PubMed  Google Scholar 

Download references

Authors’ Contribution

KM conceived the idea for the topic. KM and ND independently collected information and analysed it. All authors participated in departmental discussion on the topic and manuscript writing. All authors have seen the final version and approve of it.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kamal K. Mahawar.

Ethics declarations

Conflict of Interest Statement

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahawar, K.K., De Alwis, N., Carr, W.R.J. et al. Bariatric Surgery in Type 1 Diabetes Mellitus: A Systematic Review. OBES SURG 26, 196–204 (2016). https://doi.org/10.1007/s11695-015-1924-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1924-z

Keywords

Navigation