Bariatric surgery in the treatment of patients with obesity and type 1 diabetes: A retrospective study of clinical data
Nagi Mohammed, Adam Buckley, Mohgah Elsheikh, Matthew Allum, Sara Suliman, Mohammed Al Hadad, Carel W. le Roux, Nader Lessan, Mohamed Suliman
Abstract
Abstract Aim To evaluate the effectiveness and safety of bariatric surgery in patients with coexisting type 1 diabetes and obesity who choose to undergo bariatric surgery for weight management. Materials and Methods We conducted a retrospective, longitudinal review of the clinical data of patients with type 1 diabetes, followed up at our centre after bariatric surgery had been performed elsewhere. Results Sixty‐one patients were included, of whom 51% were women, and 57 (93%) were Emirati Arab, three (5%) were other Arab, and one (2%) was White in ethnic origin. The mean age at surgery was 31 years. A total of 42 patients (69%) underwent sleeve gastrectomy, 17 (28%) gastric bypass, and two (3%) gastric banding. In 48 patients with complete follow‐up data, improvements were observed at 12 months in the median (interquartile range [IQR]) values for body mass index (BMI; 38.5 [34.9‐40.9] to 26.1 [24.2‐29.6] kg/m 2 , P <0.001), glycated haemoglobin concentration (8.6 [7.8‐9.2]% to 7.8 [7.2‐8.5]%; P <0.001), daily insulin dose (1.0 [0.7‐1.2] to 0.8 [0.6‐0.9] units/kg/d; P <0.001), systolic blood pressure (127 [116‐136] to 116 [110‐120] mmHg; P <0.001), total cholesterol: high‐density lipoprotein cholesterol ratio (3.4 [2.9‐4.3] to 3.0 [2.6‐3.5]; P <0.001), and albuminuria. In 32 patients followed up at 3 years, the median (IQR) reduction in BMI was 10.4 (5.9‐11.7) kg/m 2 , 50% reduced or stopped antihypertensive medication and 58% reduced or stopped lipid‐modifying medication. Three patients each reported a single episode of diabetic ketoacidosis; in one case this was due to cessation of insulin treatment. Conclusions In our cohort of patients with obesity and type 1 diabetes, bariatric surgery led to significant improvements in weight and cardiometabolic variables, with modest improvements in glycaemia. Few adverse events were reported.