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Choice of Bariatric Surgery in Patients with Obesity and Type 1 Diabetes Mellitus? an Up-to-Date Systematic Review

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Abstract

Background

The prevalence of obesity in patients with type 1 diabetes mellitus (T1DM) has been increasing. Metabolic bariatric surgery (MBS) has proven to be effective in treating patients with T2DM. However, evidence for the benefit of the procedure for patients with T1DM is still limited, particularly in terms of glycemic control, demonstrating the need for a systematic review investigating this.

Method

A systematic review was performed in accordance with the PRISMA guidelines. Outcome measures such as weight loss, remission of comorbidities, pre- and post-intervention insulin requirements, and HbA1c levels were extracted.

Results

Thirty studies were included with a total of 706 patients (F = 524, M = 74, N/A = 60). The mean age was 40.01 years. The mean weight and body mass index (BMI) were 112.76 kg and 40.88 kg/m2 (24–58.9) respectively. The common procedure performed was RYGB (n = 497 (70.4%)), followed by SG (n = 131 (18.6%)). The mean decrease of insulin requirements was 92.3 IU/day (36.2–174) preoperatively to a mean of 35.8 IU/day (5–75) post-operatively. No significant trend was found for changes in HbA1c levels. The main side effects were episodes of hypoglycemia and diabetic ketoacidosis (DKA); there was no mortality. The mean %EWL was 74.57% (60–90.5%) at ≥ 6 follow-up months. Reductions in comorbidities such as hypertension and cardiovascular disease (CVD) were recorded in multiple studies.

Conclusion

Patients with obesity and T1DM can expect significant weight loss, potential resolution of comorbidities, and reduction of insulin requirements, but it does not usually result in improved glycemic control. Based on current review, best choice of bariatric surgery in such patients cannot yet be established.

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References

  1. Kashyap SR, Gatmaitan P, Brethauer S, et al. Bariatric surgery for type 2 diabetes: weighing the impact for obese patients. Cleve Clin J Med. 2010;77(7):468–76.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Koliaki C, Liatis S, le Roux CW, et al. The role of bariatric surgery to treat diabetes: current challenges and perspectives. BMC Endocr Disord. 2017;17:50.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mobasseri M, Shirmohammadi M, Amiri T, et al. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect. 2020;10(2):98–115.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Stenström G, Gottsäter A, Bakhtadze E, et al. Latent autoimmune diabetes in adults definition prevalence β-cell function and treatment. Diabetes 1. 2005;54(2):S68–72.

    Article  Google Scholar 

  5. Fellinger P, Fuchs D, Wolf P, et al. Overweight and obesity in type 1 diabetes equal those of the general population. Wiener Klinische Wochenschrift. 2019;131(3–4):55–60.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. Mahawar KK, de Alwis N, Carr WRJ, Jennings N, Schroeder N, Small PK. Bariatric surgery in type 1 diabetes mellitus: a systematic review. Obesity surgery [Internet]. Obes Surg; 2016 [cited 2021 Dec 13];26:196–204. Available from: https://pubmed.ncbi.nlm.nih.gov/26452482/

  8. Middelbeek RJ, James-Todd T, Cavallerano JD, Schlossman DK, Patti ME, Brown FM. 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(7):e104–5.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Breen DM, Rasmussen BA, Kokorovic A, Wang R, Cheung GW, Lam TK. Jejunal nutrient sensing is required for duodenal-jejunal bypass surgery to rapidly lower glucose concentrations in uncontrolled diabetes. Nat Med. 2012;18(6):950–5.

    Article  CAS  PubMed  Google Scholar 

  10. Sarruf DA, Bonner-Weir S, Schwartz MW. New clues to bariatric surgery’s benefits. Nat Med. 2012;18(6):860–1.

  11. Ichikawa H, Imoto H, Tanaka N, Musha H, Sawada S, Naitoh T, Kamei T, Unno M. Efficacy of laparoscopic sleeve gastrectomy for patient with morbid obesity and type 1 diabetes mellitus: a case report. Surg Case Rep. 2021;7(1):7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hironaka JY, Kitahama S, Sato H, Inoue M, Takahashi T, Tamori Y. Sleeve gastrectomy induced remission of slowly progressive type 1 diabetes in a morbidly obese Japanese patient. Intern Med. 2019;58(5):675–8.

    Article  PubMed  Google Scholar 

  13. Mohammed N, Buckley A, Elsheikh M, et al. Bariatric surgery in the treatment of patients with obesity and type 1 diabetes: A retrospective study of clinical data. Diabetes Obes Metab. 2021;23(7):1562–70.

    Article  PubMed  Google Scholar 

  14. Landau Z, Kowen-Sandbank G, Jakubowicz D, Raziel A, Sakran N, Zaslavsky-Paltiel I, Lerner-Geva L, Pinhas-Hamiel O. Bariatric surgery in patients with type 1 diabetes: special considerations are warranted. Ther Adv Endocrinol Metab. 2019. https://doi.org/10.1177/2042018818822207.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Uno K, Seki Y, Kasama K, et al. Mid-term results of bariatric surgery in morbidly obese Japanese patients with slow progressive autoimmune diabetes Asian Journal of Endoscopic Surgery [Internet]. John Wiley & Sons Ltd. 2018;11:238–43. https://doi.org/10.1111/ases.12443.

    Article  Google Scholar 

  16. al Sabah S, al Haddad E, Muzaffar TH, et al. Laparoscopic sleeve gastrectomy for the management of type 1 diabetes mellitus. Obes Surg Springer, New York LLC. 2017;27:3187–93.

    Google Scholar 

  17. Vilarrasa N, Rubio MA, Miñambres I, et al. Long-term outcomes in patients with morbid obesity and type 1 diabetes undergoing bariatric surgery. Obes Surg Springer, New York LLC. 2017;27:856–63.

    Google Scholar 

  18. 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 Springer, New York LLC. 2016;26:2370–8.

    Google Scholar 

  19. Rottenstreich A, Keidar A, Yuval JB, et al. Outcome of bariatric surgery in patients with type 1 diabetes mellitus our experience and review of the literature. Surg Endosc Springer, New York LLC. 2016;30:5428–33.

    Google Scholar 

  20. Maraka S, Kudva YC, Kellogg TA, et al. Bariatric surgery and diabetes: implications of type 1 versus insulin-requiring type 2. Obes. 2015;23:552–7.

    Article  CAS  Google Scholar 

  21. Robert M, Belanger P, Hould FS, et al. Should metabolic surgery be offered in morbidly obese patients with type I diabetes? Surg Obes Relat Dis Elsevier Inc. 2015;11:798–805.

    Article  Google Scholar 

  22. 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;10:9–13.

    Article  PubMed  Google Scholar 

  23. Brethauer SA, Aminian A, Rosenthal RJ, Kirwan JP, Kashyap SR, Schauer PR. Bariatric surgery improves the metabolic profile of morbidly obese patients with type 1 diabetes. Diabetes Care. 2014;37(3):e51–2.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lannoo M, Dillemans B, Van Nieuwenhove Y, Fieuws S, Mathieu C, Gillard P, D’Hoore A, Van Der Schueren B. Bariatric surgery induces weight loss but does not improve glycemic control in patients with type 1 diabetes. Diabetes Care. 2014;37(8):e173–4.

    Article  PubMed  Google Scholar 

  25. Tang A, Milner KL, Tonks K, Campbell L, Greenfield JR. Comment on Brethauer et al. Bariatric surgery improves the metabolic profile of morbidly obese patients with type 1 diabetes. Diabetes Care 2014;37:e51-e52. Diabetes Care. American Diabetes Association Inc.; 2014;37:e248–9.

  26. Ziemiański P, Lisik W, Marszałek RJ, et al. Improvement of graft function following Roux-en-Y gastric bypass surgery in a morbidly obese kidney recipient: a case report and literature review. Annal transplantation : Q Pol Transplantation Soc. 2014;19:639–42.

    Article  Google Scholar 

  27. Chuang J, Zeller MH, Inge T, Crimmins N. Bariatric surgery for severe obesity in two adolescents with type 1 diabetes. Pediatrics. 2013;132(4):e1031–4.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Dirksen C, Jacobsen SH, Bojsen-Møller KN, Jørgensen NB, Naver LS, Hvolris LE, Worm D, Madsbad S, Holst JJ, Hansen DL. 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.

  29. Fuertes-Zamorano N, Sánchez-Pernaute A, et al. Cirugía bariátrica en diabetes mellitus tipo 1; experiencia a largo plazo en dos casos. Nutr Hosp. 2013;28:1333–6.

    PubMed  Google Scholar 

  30. Reyes Garcia R, Romero Muñoz M, GalbisVerdú H. Bariatric surgery in type 1 diabetes. Endocrinología y Nutrición (English Edition). 2013;60:46–7.

    Article  Google Scholar 

  31. Manning SB, Pucci A, Batterham RL, Finer N. Latent autoimmune diabetes in adults presenting as diabetes "recurrence" after bariatric surgery: a case report. Diabetes Care. 2013;36(8):e120.

  32. Raab H, Weiner RA, Frenken M, Rett K, Weiner S. Obesity and metabolic surgery in type 1 diabetes mellitus. Nutr Hosp. 2013;28 Suppl 2:31–4.

  33. Garciacaballero M, Martínez-Moreno JM, Toval JA, Miralles F, Mínguez A, Osorio D, Mata JM, Reyes-Ortiz A. Improvement of C peptide zero BMI 24-34 diabetic patients after tailored one anastomosis gastric bypass (BAGUA). Nutr Hosp. 2013;28 Suppl 2:35–46.

  34. Mendez CE, Tanenberg RJ, Pories W. Diabetes, metabolic syndrome and obesity: targets and therapy dovepress outcomes of Roux-en-Y gastric bypass surgery for severely obese patients with type 1 diabetes: a case series report [Internet]. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2010. Available from: http://www.dovepress.com/diabetes-metabolic-syndrome-and-obesity-targets-and-therapy-journal. Accessed 1 Oct 2022

  35. Fernandez-Ranvier G, Meknat A, Guevara DE, Alenazi N, Ruiz H, Ritondale O, et al. The role of bariatric surgery in patients with obesity and type 1 diabetes mellitus. Bariatric Surgical Practice and Patient Care. 2020;15(1):46–50.

    Article  Google Scholar 

  36. Moreno-Fernandez J, Chico A. Bariatric surgery results in patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion therapy. Endocrinol y Nutrición Elsevier Doyma. 2016;63:571–2.

    Article  Google Scholar 

  37. Höskuldsdóttir G, Ekelund J, Miftaraj M, Wallenius V, Ottosson J, Näslund I, et al. Potential benefits and harms of gastric bypass surgery in obese individuals with type 1 diabetes: a nationwide, matched, observational cohort study. Diabetes Care. 2020;43(12):3079–85.

    Article  PubMed  Google Scholar 

  38. Vendrame F, Casu A, Pratley RE, Calhoun P. 2016-P: bariatric surgery may improve glucose control among patients with type 1 diabetes. Diabetes (New York, N.Y.). 2016;69(Supplement 1):2020–06. https://doi.org/10.2337/db20-2016-P.

  39. Ashrafian H, Harling L, Toma T, Athanasiou C, Nikiteas N, Efthimiou E, et al. Type 1 diabetes mellitus and bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2016;26(8):1697–704.

  40. Chow A, Switzer NJ, Dang J, Shi X, de Gara C, Birch DW, et al. A systematic review and meta-analysis of outcomes for type 1 diabetes after bariatric surgery. J Obes. 2016;2016:6170719.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Purnell JQ, Zinman B, Brunzell JD; DCCT/EDIC Research Group. The effect of excess weight gain with intensive diabetes mellitus treatment on cardiovascular disease risk factors and atherosclerosis in type 1 diabetes mellitus: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) study. Circulation. 2013;127(2):180–7.

  42. Khawandanah J. Double or hybrid diabetes: A systematic review on disease prevalence, characteristics and risk factors. Nutr Diabetes. 2019;9(1):33.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Madsbad S, Faber OK, Binder C, McNair P, Christiansen C, Transbøl I. Prevalence of residual beta-cell function in insulin-dependent diabetics in relation to age at onset and duration of diabetes. Diabetes. 1978;27(Suppl 1):262–4.

    Article  PubMed  Google Scholar 

  44. Levetan C. Distinctions between islet neogenesis and β-cell replication: implications for reversal of Type 1 and 2 diabetes. J Diabetes. 2010;2(2):76–84.

    Article  CAS  PubMed  Google Scholar 

  45. Korakas E, Kountouri A, Raptis A, Kokkinos A, Lambadiari V. Bariatric surgery and type 1 diabetes: unanswered questions. Front Endocrinol. 2020. https://doi.org/10.3389/fendo.2020.525909.

    Article  Google Scholar 

  46. Seissler J. Latent (slowly progressing) autoimmune diabetes in adults. Curr Diab Rep. 2008;8(2):94–100.

    Article  CAS  PubMed  Google Scholar 

  47. Aminian A, Kashyap SR, Burguera B, et al. Incidence and clinical features of diabetic ketoacidosis after bariatric and metabolic surgery. Diabetes Care. 2016;39(4):e50–3.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kirwan JP, Aminian A, Kashyap SR, et al. Bariatric surgery in obese patients with type 1 diabetes. Diabetes Care. 2016;39(6):941–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Parmar CD, Zakeri R, Mahawar K. A systematic review of one anastomosis/mini gastric bypass as a metabolic operation for patients with body mass index ≤ 35 kg/m2. Obes Surg. 2020;30(2):725–35.

    Article  PubMed  Google Scholar 

  50. Parmar CD, Gan J, Stier C, et al. One anastomosis/mini gastric bypass (OAGB-MGB) as revisional bariatric surgery after failed primary adjustable gastric band (LAGB) and sleeve gastrectomy (SG): a systematic review of 1075 patients. Int J Surg. 2020;81:32–8.

    Article  PubMed  Google Scholar 

  51. Parmar CD, Bryant C, Luque-de-Leon E, et al. One anastomosis gastric bypass in morbidly obese patients with BMI ≥ 50 kg/m2: a systematic review comparing it with Roux-en-Y gastric bypass and sleeve gastrectomy. Obes Surg. 2019;29(9):3039–46. https://doi.org/10.1007/s11695-019-04034-9 (PMID: 31250385).

    Article  PubMed  Google Scholar 

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Author notes

  1. Chetan Parmar and Simone Appel have contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Surgery, Whittington Health NHS Trust, London, N19 5NF, UK

    Chetan Parmar & Lyndcie Lee

  2. Medical School, University College London, London, UK

    Simone Appel

  3. Centro Multidisciplinar da Doença Metabólica, Clínica de Santo António, Reboleira, Lisbon, Portugal

    Rui Ribeiro

  4. Department of Surgery, Holy Family Hospital, P.O. Box 8, Nazareth, Israel

    Nasser Sakran

  5. Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands

    Sjaak Pouwels

  6. Department of Surgery, Agaplesion Bethanien Hospital, Frankfurt am Main, Hessen, Germany

    Sjaak Pouwels

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  1. Chetan Parmar
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  2. Simone Appel
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  4. Rui Ribeiro
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Correspondence to Chetan Parmar.

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Key points

• BS leads to significant weight loss and changes in insulin requirements, as well as a potential resolution of comorbidities.

• No significant evidence is speaking for improved glycemic control, apart from in patients with latent autoimmune diabetes in adults (LADA).

• Risk–benefit ratio needs to be critically evaluated due to the possibility of severe side effects.

• Difficult to recommend choice of bariatric surgery in these patients based on published evidence.

• Need for comprehensive clinical trials to assess safety and efficacy of different bariatric procedures in this cohort of patients.

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Parmar, C., Appel, S., Lee, L. et al. Choice of Bariatric Surgery in Patients with Obesity and Type 1 Diabetes Mellitus? an Up-to-Date Systematic Review. OBES SURG 32, 3992–4006 (2022). https://doi.org/10.1007/s11695-022-06321-4

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