Pauline Faucher1, Christine Poitou1,2, Claire Carette3, Sophie Tezenas du Montcel4,5, Charles Barsamian3, Eliabelle Touati1, Jean-Luc Bouillot6, Adriana Torcivia7, Sébastien Czernichow3,8, Jean-Michel Oppert9, Cécile Ciangura1. 1. Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University-Paris 6 (UPMC), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France. 2. INSERM, U872, Team 7 Nutriomique, Cordeliers Research Center, Paris, France. 3. Department of Nutrition, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint-Quentin University, Boulogne-Billancourt, Paris, France. 4. Department of Biostatistics, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University-Paris6 (UPMC), Paris, France. 5. INSERM U 1136, UMR S 1136, Sorbonne Universités, Paris, France. 6. Department of General, Digestive, and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, Paris, France. 7. Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Institute of Cancerology, Pierre-et-Marie- Curie University-Paris 6 (UPMC), Paris, France. 8. INSERM UMS 011-Cohortes en population, Villejuif, Paris, France. 9. Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University-Paris 6 (UPMC), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France. jean-michel.oppert@aphp.fr.
Abstract
BACKGROUND: Type 1 diabetes patients, although typically lean, experience an increased prevalence of obesity, and bariatric surgery is considered in severe cases. Bariatric surgery in such patients leads to significant weight loss and decreased insulin requirements; however, effects on glycemic control remain discussed. We assessed, in obese patients with type 1 diabetes, the effects of bariatric surgery upon body weight, body composition, and glycemic control, including the occurrence of hypoglycemic events. METHODS: Thirteen obese patients with type 1 diabetes who underwent bariatric surgery (Roux-en-Y gastric bypass n = 6, sleeve gastrectomy n = 7) were matched with obese patients without diabetes and with type 2 diabetes patients during 12 months of follow-up. Outcomes included body weight, DXA-assessed body composition, HbA1c, and incidence of hypoglycemia. RESULTS: At 12 months, median surgery-induced weight loss was 27.9 % (21.1-33.3), 26.1 % (24.8-29.7), and 27.5 % (21.8-32.1) in patients with type 1 diabetes, type 2 diabetes, and without diabetes, respectively, with no significant differences across the groups. Similar findings were observed for body fat changes. At 12 months, median HbA1c decreased from 8.3 to 7.6 % in type 1 diabetes patients versus 8.0 to 5.9 % in type 2 diabetes patients (P = 0.04 between the groups). In type 1 diabetes patients, the number of reported minor hypoglycemia increased transiently only at 6 months. Two patients reported severe hypoglycemia (one episode each). CONCLUSIONS: Type 1 diabetes patients benefit from bariatric surgery in terms of weight loss and glycemic control. Close monitoring of insulin therapy appears warranted to prevent minor hypoglycemia in the first months post-surgery.
BACKGROUND:Type 1 diabetespatients, although typically lean, experience an increased prevalence of obesity, and bariatric surgery is considered in severe cases. Bariatric surgery in such patients leads to significant weight loss and decreased insulin requirements; however, effects on glycemic control remain discussed. We assessed, in obesepatients with type 1 diabetes, the effects of bariatric surgery upon body weight, body composition, and glycemic control, including the occurrence of hypoglycemic events. METHODS: Thirteen obesepatients with type 1 diabetes who underwent bariatric surgery (Roux-en-Y gastric bypass n = 6, sleeve gastrectomy n = 7) were matched with obesepatients without diabetes and with type 2 diabetespatients during 12 months of follow-up. Outcomes included body weight, DXA-assessed body composition, HbA1c, and incidence of hypoglycemia. RESULTS: At 12 months, median surgery-induced weight loss was 27.9 % (21.1-33.3), 26.1 % (24.8-29.7), and 27.5 % (21.8-32.1) in patients with type 1 diabetes, type 2 diabetes, and without diabetes, respectively, with no significant differences across the groups. Similar findings were observed for body fat changes. At 12 months, median HbA1c decreased from 8.3 to 7.6 % in type 1 diabetespatients versus 8.0 to 5.9 % in type 2 diabetespatients (P = 0.04 between the groups). In type 1 diabetespatients, the number of reported minor hypoglycemia increased transiently only at 6 months. Two patients reported severe hypoglycemia (one episode each). CONCLUSIONS:Type 1 diabetespatients benefit from bariatric surgery in terms of weight loss and glycemic control. Close monitoring of insulin therapy appears warranted to prevent minor hypoglycemia in the first months post-surgery.
Entities:
Keywords:
Body composition; Hypoglycemia; Metabolic control; Obesity; Type 1 diabetes
Authors: C Dirksen; N B Jørgensen; K N Bojsen-Møller; S H Jacobsen; D L Hansen; D Worm; J J Holst; S Madsbad Journal: Diabetologia Date: 2012-04-27 Impact factor: 10.122
Authors: Philip R Schauer; Deepak L Bhatt; John P Kirwan; Kathy Wolski; Stacy A Brethauer; Sankar D Navaneethan; Ali Aminian; Claire E Pothier; Esther S H Kim; Steven E Nissen; Sangeeta R Kashyap Journal: N Engl J Med Date: 2014-03-31 Impact factor: 91.245
Authors: Anita P Courcoulas; Steven H Belle; Rebecca H Neiberg; Sheila K Pierson; Jessie K Eagleton; Melissa A Kalarchian; James P DeLany; Wei Lang; John M Jakicic Journal: JAMA Surg Date: 2015-10 Impact factor: 14.766
Authors: Silvio E Inzucchi; Richard M Bergenstal; John B Buse; Michaela Diamant; Ele Ferrannini; Michael Nauck; Anne L Peters; Apostolos Tsapas; Richard Wender; David R Matthews Journal: Diabetes Care Date: 2015-01 Impact factor: 19.112
Authors: John B Buse; Sonia Caprio; William T Cefalu; Antonio Ceriello; Stefano Del Prato; Silvio E Inzucchi; Sue McLaughlin; Gordon L Phillips; R Paul Robertson; Francesco Rubino; Richard Kahn; M Sue Kirkman Journal: Diabetes Care Date: 2009-11 Impact factor: 19.112
Authors: Kimberly A Driscoll; Karen D Corbin; David M Maahs; Richard Pratley; Franziska K Bishop; Anna Kahkoska; Korey K Hood; Elizabeth Mayer-Davis Journal: Curr Diab Rep Date: 2017-08 Impact factor: 4.810
Authors: Scott J Pilla; Nisa M Maruthur; Michael A Schweitzer; Thomas H Magnuson; James J Potter; Jeanne M Clark; Clare J Lee Journal: Obes Surg Date: 2018-01 Impact factor: 4.129
Authors: Anwar E Ahmed; Wala R Alanazi; Rayan A Ahmed; Wijdan AlJohi; Doaa A AlBuraikan; Budor A AlRasheed; Bashayr I ALMuqbil; Ali A Al-Zahrani; Zeyad M Yousef; Hamdan Al-Jahdali Journal: Diabetes Metab Syndr Obes Date: 2018-06-12 Impact factor: 3.168