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.
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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.
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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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DOI: https://doi.org/10.1007/s00423-023-02788-6