Laparoscopic Sleeve Gastrectomy for the Management of Type 1 Diabetes Mellitus

  • Salman Al Sabah
  • Eliana Al Haddad
  • Talal H. Muzaffar
  • Ahmad Almulla
Original Contributions
  • 137 Downloads

Abstract

Background

The prevalence of obesity is on a continuous rise worldwide, with major studies clearly correlating obesity with the development of chronic metabolic disorders including type 2 diabetes. Bariatric surgery has proven to be beneficial in the management of this condition; however, a limited number of studies exist on its effect on type 1 diabetes.

Objective

The objective of this study is to evaluate the outcome of laparoscopic sleeve gastrectomy for the management of patients with type 1 diabetes (DM1).

Setting

This is a retrospective cohort study conducted in a university hospital and private practice in Kuwait.

Research Design and Methods

Analysis was conducted on 10 patients diagnosed with type 1 diabetes that underwent bariatric surgery from October 2008 until December 2016 at Amiri Hospital and Royale Hayat Hospital, Kuwait. Primary parameters included body mass index (BMI), % excess weight (%EWL) loss at follow-up, glycosylated hemoglobin (A1C), and basal insulin requirements. Total cholesterol readings and fasting blood glucose (FBS) levels were considered secondary outcomes. Statistical analysis of the data was carried out using Statistical Package for the Social Sciences (SPSS) software.

Results

Mean BMI showed a reduction from 41.9 ± 5.4 to 31.4 ± 8.4 kg/m2. Mean %EWL after the follow-up period was 74.4 ± 25.3%. A1C levels failed to show a significant difference 12 months post-op (p = 0.189). Cholesterol levels did not display a significant decrease either (p = 0.447). When it came to insulin requirements, a significant difference was perceived, with the mean number of units of insulin required dropping from 76.6 to 18.2 (p = 0.026). FBS readings also showed a drop from 15.1 ± 3.8 to 7.8 ± 2.9 mmol/L (p = 0.001).

Conclusions

Laparoscopic sleeve gastrectomy resulted in significant weight loss, comorbidity resolution as well as reduction in their insulin doses post-op. However, glycemic control does not seem to show significant improvement in these patients. Larger, more long-term studies are needed to reach a definite conclusion on this topic.

Keywords

Obesity Diabetes Type 1 Sleeve gastrectomy Kuwait 

References

  1. 1.
    State of Victoria (1999) Victorian Burden of Disease Study: Morbidity Public Health Division, Department of Human Services Melbourne Victoria, Australia.Google Scholar
  2. 2.
    Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345:790–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–9.CrossRefPubMedGoogle Scholar
  4. 4.
    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;222:339–50. discussion 350-332CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Czupryniak L, Wiszniewski M, Szymanski 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
  6. 6.
    Brethauer SA, Aminian A, Rosenthal RJ, et al. Bariatric surgery improves the metabolic profile of morbidly obese patients with type 1 diabetes. Diabet Care. 2014;37:e51–2.CrossRefGoogle Scholar
  7. 7.
    Maraka S, Kudva YC, Kellogg TA, et al. Bariatric surgery and diabetes: implications of type 1 versus insulin-requiring type 2. Obesity. 2015;23(3):552–7. WebCrossRefPubMedGoogle Scholar
  8. 8.
    The American Society for Metabolic and Bariatric Surgery.Google Scholar
  9. 9.
    NDEI.org. Guidelines for Hypoglycemia in Diabetes ADA/Endocrine Society. N.p., n.d. Web. 04 July 2016.
  10. 10.
    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.PubMedGoogle Scholar
  11. 11.
    Conway B, Miller RG, Costacou T, et al. Adiposity and mortality in type 1 diabetes. Int J Obes. 2009;33:796–805.CrossRefGoogle Scholar
  12. 12.
    Nathan DM. Long-term complications of diabetesmellitus. N Engl JMed. 1993;328:1676–85.CrossRefGoogle Scholar
  13. 13.
    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:e178–82.CrossRefPubMedGoogle Scholar
  14. 14.
    De Block CE, De Leeuw IH, Van Gaal LF. Impact of overweight on chronic microvascular complications in type 1 diabetic patients. Diabetes Care. 2005;28:1649–55.CrossRefPubMedGoogle Scholar
  15. 15.
    Kirwan JP, Brethauer SA, Aminian A, et al. Response to comments on Brethauer et al. Bariatric surgery improves the metabolic profile of morbidly obese patients with type 1 diabetes. Diabetes Care. 2014;37:e51–2. Diabetes Care 2014;37:e251CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Chillarón JJ, Benaiges D, Mañé L, et al. Obesity and type 1 diabetes mellitus management. Minerva Endocrinol. 2015;40(1):53–60.PubMedGoogle Scholar
  17. 17.
    Dixon JB, le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet. 2012;379:2300–11.CrossRefPubMedGoogle Scholar
  18. 18.
    Rubino F, Schauer PR, Kaplan LM, et al. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med. 2010;61:393–411.CrossRefPubMedGoogle Scholar
  19. 19.
    Thaler JP, Cummings DE. Minireview: hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150:2518–25.CrossRefPubMedGoogle Scholar
  20. 20.
    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 189–90CrossRefPubMedGoogle Scholar
  21. 21.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    Pozzilli P, Guglielmi C, Caprio S, et al. Obesity, autoimmunity, and double diabetes in youth. Diabetes Care. 2011;34(Suppl 2):S166–70.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Golomb I, Ben David M, Glass A, et al. Long-term metabolic effects of laparoscopic sleeve gastrectomy. JAMA Surg. 2015;150(11):1051. Web.CrossRefPubMedGoogle Scholar
  26. 26.
    Robert M, Belanger P, Hould FS, et al. Shouldmetabolic surgery be offered in morbidly obese patients with type I diabetes? Surg Obes Relat Dis. 2014; doi:10.1016/j.soard.2014.12.016.
  27. 27.
    Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56. e245CrossRefPubMedGoogle Scholar
  28. 28.
    Sjostrom 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
  29. 29.
    Aminian A, Zelisko A, Kirwan JP, et al. Exploring the impact of bariatric surgery on high density lipoprotein. Surg Obes Relat Dis. 2015;11:238–47.CrossRefPubMedGoogle Scholar
  30. 30.
    Schauer PR, Bhatt DL, Kirwan JP, et al. STAMPEDE investigators. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370:2002–13.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577–85.CrossRefPubMedGoogle Scholar
  32. 32.
    Ikramuddin S, Korner J, Lee WJ, et al. Rouxen-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the diabetes surgery study randomized clinical trial. JAMA. 2013;309:2240–9.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–23.PubMedGoogle Scholar
  34. 34.
    Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308:1122–31.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Brethauer SA, 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;258:628–36. discussion 636–637PubMedPubMedCentralGoogle Scholar
  36. 36.
    Aminian A, Daigle CR, Romero-Talamás H, et al. Risk prediction of complications of metabolic syndrome before and 6 years after gastric bypass. Surg Obes Relat Dis. 2014;10:576–82.CrossRefPubMedGoogle Scholar
  37. 37.
    Romero-Talamás H, Aminian A, Corcelles R, et al. Psoriasis improvement after bariatric surgery. Surg Obes Relat Dis. 2014;10:1155–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Romero-Talamás H, Daigle CR, Aminian A, et al. The effect of bariatric surgery on gout: a comparative study. Surg Obes Relat Dis. 2014;10:1161–5.CrossRefPubMedGoogle Scholar
  39. 39.
    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.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Al Amiri HospitalKuwait CityKuwait

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