Overweight patients with type 1 diabetes may make good candidates for bariatric surgery, but unlike with type 2 disease, the procedure doesn't always work.
In a small study, 10 severely obese patients with uncontrolled type 1 diabetes who underwent bariatric surgery lost weight and had improved glycemic control and a better metabolic profile 3 years later. The results were published online February 20 in a letter to the editor in Diabetes Care.
The weight loss was “remarkable and sustained,” note the authors, led by Stacy A. Brethauer, Maryland, from Cleveland Clinic, Ohio.
Dr. Brethauer told Medscape Medical News that physicians may be reluctant to refer obese patients with type 1 diabetes for bariatric surgery, “because of the thought that maybe it wouldn’t help — there’s just going to be no chance their pancreas will recover.
“[However], what this paper shows is that some patients with type 1 diabetes would benefit from these operations — [not just] in terms of their quality of life but also their glucose control,” he added.
Patients with type 2 diabetes typically develop worsening insulin resistance with weight gain and a growing body of evidence suggests that some of these individuals can achieve diabetes remission after losing weight with bariatric surgery, Dr. Brethauer noted.
Those with type 1 diabetes may also become obese, and although they may not achieve diabetes remission, they might require less insulin therapy after bariatric surgery, he explained.
Fewer than 10 cases of type 1 diabetic patients who’ve had bariatric surgery have been published, but in all instances they lost a significant amount of weight and improved their glucose control.
In this series, Dr. Brethauer and colleagues examined clinical outcomes and metabolic parameters in morbidly obese individuals with uncontrolled type 1 diabetes who had undergone bariatric surgery at their center from 2005 to 2012. Each had an average of 10 comorbidities, including cardiovascular disease, sleep apnea, gastroesophageal reflux, hypertension, and hyperlipidemia.
“The findings of this study, which is the largest case series to date, indicate that bariatric surgery leads to a remarkable and sustained weight loss in severely obese patients with type 1 diabetes and results in significant improvement in their glycemic status and comorbid conditions,” the authors summarize.
“Longer follow-up studies in a larger cohort” are required, they conclude.