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Obesity Surgery
Published in: Obesity Surgery 12/2017

01-12-2017 | Original Contributions

Laparoscopic Sleeve Gastrectomy for the Management of Type 1 Diabetes Mellitus

Authors: Salman Al Sabah, Eliana Al Haddad, Talal H. Muzaffar, Ahmad Almulla

Published in: Obesity Surgery | Issue 12/2017

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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.
Literature
1.
State of Victoria (1999) Victorian Burden of Disease Study: Morbidity Public Health Division, Department of Human Services Melbourne Victoria, Australia.
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.CrossRefPubMed
3.
Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–9.CrossRefPubMed
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 350-332CrossRefPubMedPubMedCentral
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.CrossRefPubMed
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.CrossRef
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. WebCrossRefPubMed
8.
The American Society for Metabolic and Bariatric Surgery.
9.
NDEI.​org. Guidelines for Hypoglycemia in Diabetes ADA/Endocrine Society. N.p., n.d. Web. 04 July 2016.
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.PubMed
11.
Conway B, Miller RG, Costacou T, et al. Adiposity and mortality in type 1 diabetes. Int J Obes. 2009;33:796–805.CrossRef
12.
Nathan DM. Long-term complications of diabetesmellitus. N Engl JMed. 1993;328:1676–85.CrossRef
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.CrossRefPubMed
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.CrossRefPubMed
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:e251CrossRefPubMedPubMedCentral
16.
Chillarón JJ, Benaiges D, Mañé L, et al. Obesity and type 1 diabetes mellitus management. Minerva Endocrinol. 2015;40(1):53–60.PubMed
17.
Dixon JB, le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet. 2012;379:2300–11.CrossRefPubMed
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.CrossRefPubMed
19.
Thaler JP, Cummings DE. Minireview: hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150:2518–25.CrossRefPubMed
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 189–90CrossRefPubMed
21.
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.CrossRefPubMed
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.CrossRefPubMed
24.
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.CrossRefPubMed
26.
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. e245CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMedPubMedCentral
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.CrossRefPubMed
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.CrossRefPubMedPubMedCentral
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.PubMed
34.
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 636–637PubMedPubMedCentral
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.CrossRefPubMed
37.
Romero-Talamás H, Aminian A, Corcelles R, et al. Psoriasis improvement after bariatric surgery. Surg Obes Relat Dis. 2014;10:1155–9.CrossRefPubMed
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.CrossRefPubMed
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.PubMedPubMedCentral
Metadata
Title
Laparoscopic Sleeve Gastrectomy for the Management of Type 1 Diabetes Mellitus
Authors
Salman Al Sabah
Eliana Al Haddad
Talal H. Muzaffar
Ahmad Almulla
Publication date
01-12-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 12/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2777-4

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