Obesity Surgery

, Volume 27, Issue 4, pp 856–863 | Cite as

Long-Term Outcomes in Patients with Morbid Obesity and Type 1 Diabetes Undergoing Bariatric Surgery

  • Nuria VilarrasaEmail author
  • Miguel Angel RubioEmail author
  • Inka Miñambres
  • Lillian Flores
  • Assumpta Caixàs
  • Andrea Ciudin
  • Marta Bueno
  • Pedro Pablo García-Luna
  • María D. Ballesteros-Pomar
  • Marisol Ruiz-Adana
  • Albert Lecube
Original Paper



This study aims to describe the long-term outcomes of bariatric surgery in a cohort of patients with type 1 diabetes (T1DM).


Thirty-two patients with T1DM and initial BMI of 41.3 ± 4.8 kg/m2 were studied, 18.7 % undergoing duodenal switch (DS), 34.4 % gastric bypass, and 46.9 % sleeve gastrectomy and followed-up after surgery for 4.6 ± 2.6 years. Changes in BMI, HbA1c, insulin requirements, evolution of comorbidities, and microvascular complications were registered annually after surgery.


Percentage of total weight loss (%TWL) 12 months after surgery was 30.4 ± 9.2 % and at 5 years, it decreased to 28.1 ± 11.5 % (p = 0.02). HbA1c was reduced during the first year from 8.5 ± 1.3 to 7.9 ± 1.4 %, p = 0.016. In the long-term, HbA1c returned to baseline values. There was a sustained reduction of 51 % in total daily insulin dose, and the decrease in the number of patients with hypertension, dyslipidemia, and obstructive sleep apnea was 42.8, 25, and 66 %, respectively. Retinopathy remained mainly unaffected, and 25 % of patients with microalbuminuria regressed to normoalbuminuria.


Bariatric surgery in patients with T1DM mainly provides benefits of weight reduction, on insulin requirements, obesity comorbidities, and some benefits in diabetes complications, but might have only minimal effect on the glycemic control in the long term.

This trial was registered at as ISRCTN49980913.


Type 1 diabetes Bariatric surgery Morbid obesity Metabolic control Microvascular complications 



We would like to thank The Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN) for participating and providing data for this study. The authors thank Dr. Jonathan Rogerson for his valuable help with the English version of the manuscript.

Compliance with Ethical Standards


This study was funded by grant “Ajuts per a projectes de recerca clínica de l’Hospital Universitari de Bellvitge (2011-PR143/11).”

Conflict of Interest

The authors declare that they have no conflict of interest.

Grant Support

Dr. Vilarrasa is currently receiving a grant “Ajuts per a projectes de recerca clínica de l’Hospital Universitari de Bellvitge (2011-PR143/11).”


  1. 1.
    Rodacki M. Obesity and dyslipidemia-an urgent matter in youth from the general population and in type 1 diabetic patients. Arch Endocrinol Metab. 2015;59:199–201.CrossRefPubMedGoogle Scholar
  2. 2.
    Baskaran C, Volkening LK, Diaz M, et al. A decade of temporal trends in overweight/obesity in youth with type 1 diabetes after de Diabetes Control and Complications Trial. Pediatr Diabetes. 2015;16:263–70.CrossRefPubMedGoogle Scholar
  3. 3.
    Palomo Atance E, Giralt Muiña P, Ballester Herrera MJ, et al. Prevalence of obesity and cardiovascular risk factors in a group of paediatric patients with type 1 diabetes. An Pediatr (Barc). 2013;78:382–8.CrossRefGoogle Scholar
  4. 4.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMedGoogle Scholar
  5. 5.
    Sjöström L, Lindroos AK, Peltonen M, et al. Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefPubMedGoogle Scholar
  6. 6.
    Brethauer S, Aminian A, Romero-Talamás H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258:628–37.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308:1122–31.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Arterburn D, Bogart A, Sherwood N, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric by-pass. Obes Surg. 2013;23:93–102.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Czupryniak L, Strzelczyk J, Cypryk K, et al. Gastric bypass surgery in severely obese type 1 diabetic patients. Diabetes Care. 2004;27:2561–2.CrossRefPubMedGoogle Scholar
  10. 10.
    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;20:506–8.CrossRefPubMedGoogle Scholar
  11. 11.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    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;28:1333–6.PubMedGoogle Scholar
  13. 13.
    Chuang J, Zeller MH, Inge T, et al. Bariatric surgery for severe obesity in two adolescents with type 1 diabetes. Pediatrics. 2013;132:e1031–4.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Raab H, Weiner RA, Freken M, et al. Obesity and metabolic surgery in type 1 diabetic mellitus. Nutr Hosp. 2013;28:31–4.PubMedGoogle Scholar
  15. 15.
    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;24:1442–6.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    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:e269–74.CrossRefPubMedGoogle Scholar
  17. 17.
    Blanco J, Jimenez A, Casamitjana R, et al. Relevance of beta-cell function for improved glycemic control after gastric bypass surgery. Surg Obes Relat Dis. 2014;10:9–13.CrossRefPubMedGoogle Scholar
  18. 18.
    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:e51–2.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Tang A, Milner KL, Tonks K, et al. Comment on Brethauer et al. bariatric surgery improves the metabolic profile of morbidly obese patients with type 1 diabetes. Diabetes Care. 2014;37:e51–2.CrossRefGoogle Scholar
  20. 20.
    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:e173–4.CrossRefPubMedGoogle Scholar
  21. 21.
    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:e104–5.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Maraka S, Kudva Y, Kellogg TA, et al. Bariatric surgery and diabetes: implications of type 1 versus insulin-requiring type 2. Obesity. 2015;23:552–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Robert M, Belanger P, Hould FS, et al. Should metabolic surgery be offered in morbidly obese patients with type 1 diabetes? Surg Obes Relat Dis. 2015;11:798–805.CrossRefPubMedGoogle Scholar
  24. 24.
    American Diabetes Association. Standards of medical care in diabetes 2016. Diabetes Care. 2016;39(suppl 1):S1–2.Google Scholar
  25. 25.
    Mahawar KK, De Alwis N, Carr WR, et al. Bariatric surgery in type 1 diabetes mellitus: a systematic review. Obes Surg. 2016;26:196–204.CrossRefPubMedGoogle Scholar
  26. 26.
    Kirwan J, Aminian A, Kashyap S, et al. Bariatric surgery in obese patients with type 1 diabetes. Diabetes Care. 2016;39:941–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Libman IM, Miller KM, DiMeglio LA, et al. Effect of metformin added to insulin on glycemic control among overweight/obese adolescents with type 1 diabetes: a randomized clinical trial. JAMA. 2015;314:2241–50.CrossRefPubMedGoogle Scholar
  28. 28.
    Dejgaard TF, Frandsen CS, Hansen TS, et al. Efficacy and safety of liraglutide for overweight adult patients with type 1 diabetes and insufficient glycaemic control (Lira-1): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2016;4:221–32.CrossRefPubMedGoogle Scholar
  29. 29.
    Hanaire H, Bertrand M, Guerci B, et al. High glycemic variability assessed by continuous glucose monitoring after surgical treatment of obesity by gastric bypass. Diabetes Technol Ther. 2011;13:625–30.CrossRefPubMedGoogle Scholar
  30. 30.
    Aminian A, Kashyap S, Burguera B, et al. Incidence and clinical features of diabetic ketoacidosis alter bariatric and metabolic surgery. Diabetes Care. 2016;39:e50–3.CrossRefPubMedGoogle Scholar
  31. 31.
    Miras AD, Chuah LL, Lascaratos G, et al. Bariatric surgery does not exacerbate and may be beneficial for the microvascular complications of type 2 diabetes. Diabetes Care. 2012;35:e81.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Thomas RL, Prior SL, Barry JD, et al. Does bariatric surgery adversely impact on diabetic retinopathy in persons with morbid obesity and type 2 diabetes? A pilot study. J Diabetes Complicat. 2014;28:191–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Heneghan HM, Cetin D, Navaneethan SD, et al. Effects of bariatric surgery on diabetic nephropathy after 5 years of follow-up. Surg Obes Relat Dis. 2013;9:7–14.CrossRefPubMedGoogle Scholar
  34. 34.
    Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311:2297–304.CrossRefPubMedGoogle Scholar
  35. 35.
    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:e 178–82.CrossRefGoogle Scholar
  36. 36.
    Franchini S, Savino A, Marcovecchio ML, et al. The effect of obesity and type 1 diabetes on renal function in children and adolescents. Pediatr Diabetes. 2015;16(6):427–33.CrossRefPubMedGoogle Scholar
  37. 37.
    De Luca M, Angrisani L, Himpens J, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO. Obes Surg. 2016;26:1659–96.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Nuria Vilarrasa
    • 1
    • 2
    Email author
  • Miguel Angel Rubio
    • 3
    Email author
  • Inka Miñambres
    • 4
  • Lillian Flores
    • 2
    • 5
  • Assumpta Caixàs
    • 6
  • Andrea Ciudin
    • 7
  • Marta Bueno
    • 8
  • Pedro Pablo García-Luna
    • 9
  • María D. Ballesteros-Pomar
    • 10
  • Marisol Ruiz-Adana
    • 11
  • Albert Lecube
    • 8
  1. 1.Department of Endocrinology and NutritionHospital Universitario de Bellvitge-IDIBELL, L’Hospitalet de LlobregatBarcelonaSpain
  2. 2.CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas AsociadasInstituto de Salud Carlos IIIMadridSpain
  3. 3.Department of Endocrinology and NutritionHospital Clínico San Carlos, IDISSCMadridSpain
  4. 4.Endocrinology and Nutrition DepartmentHospital de La Santa Creu i Sant PauBarcelonaSpain
  5. 5.Department of Endocrinology and Nutrition, Obesity UnitHospital Clínic UniversitariBarcelonaSpain
  6. 6.Endocrinology and Nutrition Department, Corporació Sanitària Parc Taulí, Institut de Recerca I3PTSabadell University Hospital (UAB)SabadellSpain
  7. 7.Endocrinology and Nutrition Department, Morbid Obesity UnitHospital Vall d’HebronBarcelonaSpain
  8. 8.Endocrinology and Nutrition DepartmentHospital Universitari Arnau de VilanovaLleidaSpain
  9. 9.U. Nutricion. U.G. Endocrinologia y NutricionHospital Universitario Virgen del RocíoSevillaSpain
  10. 10.Endocrinology and Nutrition DepartmentComplejo Asistencial Universitario de LeónLeónSpain
  11. 11.Endocrinology and Nutrition DepartmentHospital Regional Universitario Carlos HayaMálagaSpain

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