Current status of metabolic surgery in patients with type I diabetes mellitus and obesity: a nationwide multicenter study

PurposeWhile obesity is prevalent among patients with type I diabetes mellitus (T1DM), the effects of metabolic surgery on patients with T1DM have not been adequately investigated. The study aims to investigate the perioperative outcomes and the improvement of comorbidity 1 year following metabolic surgery amongst this patient population.MethodsIn this study, we evaluated the effects of sleeve gastrectomy (SG) and Roux-Y gastric bypass (RYGB) on patients with T1DM and insulin resistance.ResultsOne hundred forty-nine patients (SG n = 91 and RYGB n = 58) with obesity, T1DM, and insulin resistance were analyzed. There was no significant difference in BMI reduction and %EWL 1 year after surgery between the two groups. In the SG group, BMI reduction was 6.5 kg/m(2) versus 5.9 kg/m(2) in the RYGB group (p=0.406). The %EWL was 68.2 +/- 25.2 in the RYGB group and 64.3 +/- 21.5 in SG (p=0.332). There was also no significant difference in weight loss between the two groups (14.9 +/- 5.4 kg in SG vs. 14.2 +/- 7 kg in RYGB; p=0.548). In all patients, insulin requirements decreased after surgery, and in 22% of patients, insulin requirements were equivalent to those of normal-weight individuals. There was a significantly higher rate of remission of reflux in RYGB patients than in SG patients (94 center dot 44% vs 29 center dot 41; p<0.001).ConclusionPatients with obesity and T1DM may benefit from metabolic surgery. Both methods produce satisfactory results in this group of patients regarding daily insulin requirements and treatment of obesity-related diseases. However, the decision of which procedure should be carried out still depends on the patient's general condition and the surgeon's technical ability.