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Bariatric Surgery in Obese Patients with Type 1 Diabetes: Effects on Weight Loss and Metabolic Control

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Abstract

Background

Type 1 diabetes patients, although typically lean, experience an increased prevalence of obesity, and bariatric surgery is considered in severe cases. Bariatric surgery in such patients leads to significant weight loss and decreased insulin requirements; however, effects on glycemic control remain discussed. We assessed, in obese patients with type 1 diabetes, the effects of bariatric surgery upon body weight, body composition, and glycemic control, including the occurrence of hypoglycemic events.

Methods

Thirteen obese patients with type 1 diabetes who underwent bariatric surgery (Roux-en-Y gastric bypass n = 6, sleeve gastrectomy n = 7) were matched with obese patients without diabetes and with type 2 diabetes patients during 12 months of follow-up. Outcomes included body weight, DXA-assessed body composition, HbA1c, and incidence of hypoglycemia.

Results

At 12 months, median surgery-induced weight loss was 27.9 % (21.1–33.3), 26.1 % (24.8–29.7), and 27.5 % (21.8–32.1) in patients with type 1 diabetes, type 2 diabetes, and without diabetes, respectively, with no significant differences across the groups. Similar findings were observed for body fat changes. At 12 months, median HbA1c decreased from 8.3 to 7.6 % in type 1 diabetes patients versus 8.0 to 5.9 % in type 2 diabetes patients (P = 0.04 between the groups). In type 1 diabetes patients, the number of reported minor hypoglycemia increased transiently only at 6 months. Two patients reported severe hypoglycemia (one episode each).

Conclusions

Type 1 diabetes patients benefit from bariatric surgery in terms of weight loss and glycemic control. Close monitoring of insulin therapy appears warranted to prevent minor hypoglycemia in the first months post-surgery.

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Acknowledgments

The authors express their thanks to Sophie Festis, Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France, for the technical assistance with DXA measurements and to Florence Marchelli, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris, France, for the assistance with data management.

Authors’ Contributions

P.F., C.P., S.C., J-M.O., and C.Ci. conceived and carried out the experiments. P.F., C.P., C.Ca., C.B., E.T., S.C., and J-M.O. researched the data. S.T.M. performed the statistical analyses. All authors were involved in writing the paper and had final approval of the submitted and published versions. J-M.O. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University-Paris 6 (UPMC), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France

    Pauline Faucher, Christine Poitou, Eliabelle Touati, Jean-Michel Oppert & Cécile Ciangura

  2. INSERM, U872, Team 7 Nutriomique, Cordeliers Research Center, Paris, France

    Christine Poitou

  3. Department of Nutrition, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint-Quentin University, Boulogne-Billancourt, Paris, France

    Claire Carette, Charles Barsamian & Sébastien Czernichow

  4. Department of Biostatistics, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University-Paris6 (UPMC), Paris, France

    Sophie Tezenas du Montcel

  5. INSERM U 1136, UMR S 1136, Sorbonne Universités, Paris, France

    Sophie Tezenas du Montcel

  6. Department of General, Digestive, and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, Paris, France

    Jean-Luc Bouillot

  7. Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Institute of Cancerology, Pierre-et-Marie- Curie University-Paris 6 (UPMC), Paris, France

    Adriana Torcivia

  8. INSERM UMS 011-Cohortes en population, Villejuif, Paris, France

    Sébastien Czernichow

Authors
  1. Pauline Faucher
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  2. Christine Poitou
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  3. Claire Carette
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  4. Sophie Tezenas du Montcel
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  5. Charles Barsamian
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  6. Eliabelle Touati
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  7. Jean-Luc Bouillot
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  9. Sébastien Czernichow
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  10. Jean-Michel Oppert
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  11. Cécile Ciangura
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Corresponding author

Correspondence to Jean-Michel Oppert.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study has been approved by the Research Ethics Committee of Hôtel-Dieu Hospital (CPP Ile de France 1), Paris, in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Faucher, P., Poitou, C., Carette, C. et al. Bariatric Surgery in Obese Patients with Type 1 Diabetes: Effects on Weight Loss and Metabolic Control. OBES SURG 26, 2370–2378 (2016). https://doi.org/10.1007/s11695-016-2106-3

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