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Current status of metabolic surgery in patients with type I diabetes mellitus and obesity: a nationwide multicenter study

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Abstract

Purpose

While obesity is prevalent among patients with type I diabetes mellitus (T1DM), the effects of metabolic surgery on patients with T1DM have not been adequately investigated. The study aims to investigate the perioperative outcomes and the improvement of comorbidity 1 year following metabolic surgery amongst this patient population.

Methods

In this study, we evaluated the effects of sleeve gastrectomy (SG) and Roux-Y gastric bypass (RYGB) on patients with T1DM and insulin resistance.

Results

One hundred forty-nine patients (SG n = 91 and RYGB n = 58) with obesity, T1DM, and insulin resistance were analyzed. There was no significant difference in BMI reduction and %EWL 1 year after surgery between the two groups. In the SG group, BMI reduction was 6.5 kg/m2 versus 5.9 kg/m2 in the RYGB group (p=0.406). The %EWL was 68.2 ± 25.2 in the RYGB group and 64.3 ± 21.5 in SG (p=0.332). There was also no significant difference in weight loss between the two groups (14.9 ± 5.4 kg in SG vs. 14.2 ± 7 kg in RYGB; p=0.548). In all patients, insulin requirements decreased after surgery, and in 22% of patients, insulin requirements were equivalent to those of normal-weight individuals. There was a significantly higher rate of remission of reflux in RYGB patients than in SG patients (94·44% vs 29·41; p<0.001).

Conclusion

Patients with obesity and T1DM may benefit from metabolic surgery. Both methods produce satisfactory results in this group of patients regarding daily insulin requirements and treatment of obesity-related diseases. However, the decision of which procedure should be carried out still depends on the patient’s general condition and the surgeon’s technical ability.

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Acknowledgements

We thank Mr. Hukauf for his contribution in the statistical analysis of our data.

Author information

Authors and Affiliations

  1. Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany

    Omar Thaher & Jamal Driouch

  2. Department of Surgery, SRH Hospital Naumburg, Humboldtstraße 31, 06618, Naumburg, Germany

    Volodymyr Iaroshevych

  3. StatConsult Society for Clinical and Health Services Research GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany

    Martin Hukauf

  4. Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Roland S. Croner

  5. Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany

    Christine Stroh

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Contributions

Omar Thaher, MD, and Volodymyr Iaroshevych: study concept, verified data, literature review, manuscript writing, and manuscript revision. Jamal Driouch MD: literature review, manuscript writing. Martin Hukauf: preparation of data for statistical analysis and approval of statistical results and outcomes. Prof. Roland S. Croner, MD: study concept, manuscript writing, revision, and final approval of the manuscript. Prof. Christine Stroh, MD: study concept, preparation, and verification of data for statistical analysis, manuscript revision, and final approval of the manuscript.

All the authors confirm that they have full access to the study data, contributed to the article, and approved the submitted version.

Corresponding author

Correspondence to Omar Thaher.

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Ethical approval

No formal consent was obtained for this study. All data were gathered and analyzed in accordance with the privacy and ethical standards of the institutional and national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all the participants included in the study.

Conflict of interest

Martin Hukauf is employed by the company StatConsult GmbH, Magdeburg. Omar Thaher, Volodymyr Iaroshevych, Jamal Driouch, Roland S. Croner, and Christine Stroh declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Thaher, O., Iaroshevych, V., Driouch, J. et al. Current status of metabolic surgery in patients with type I diabetes mellitus and obesity: a nationwide multicenter study. Langenbecks Arch Surg 408, 46 (2023). https://doi.org/10.1007/s00423-023-02788-6

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