Nuria Vilarrasa1,2, Miguel Angel Rubio3, Inka Miñambres4, Lillian Flores5,6, Assumpta Caixàs7, Andrea Ciudin8, Marta Bueno9, Pedro Pablo García-Luna10, María D Ballesteros-Pomar11, Marisol Ruiz-Adana12, Albert Lecube9. 1. Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, c/ Feixa Llarga s/n, 08907, Barcelona, Spain. nuriavilarrasa@yahoo.es. 2. CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain. nuriavilarrasa@yahoo.es. 3. Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, IDISSC, Martín Lagos s/n, 28040, Madrid, Spain. marubioh@gmail.com. 4. Endocrinology and Nutrition Department, Hospital de La Santa Creu i Sant Pau, C/Sant Antoni Maria Claret 167, 08025, Barcelona, Spain. 5. CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain. 6. Department of Endocrinology and Nutrition, Obesity Unit, Hospital Clínic Universitari, Villarroel 170, 08036, Barcelona, Spain. 7. Endocrinology and Nutrition Department, Corporació Sanitària Parc Taulí, Institut de Recerca I3PT, Sabadell University Hospital (UAB), c/ Parc Taulí no. 1, 08208, Sabadell, Spain. 8. Endocrinology and Nutrition Department, Morbid Obesity Unit, Hospital Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain. 9. Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Avda. Rovira Roure 80, 25198, Lleida, Spain. 10. U. Nutricion. U.G. Endocrinologia y Nutricion, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013, Sevilla, Spain. 11. Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, Altos de Nava s/n, 24001, León, Spain. 12. Endocrinology and Nutrition Department, Hospital Regional Universitario Carlos Haya, Av. De Carlos Haya s/n, 29010, Málaga, Spain.
Abstract
BACKGROUND: This study aims to describe the long-term outcomes of bariatric surgery in a cohort of patients with type 1 diabetes (T1DM). METHODS: Thirty-two patients with T1DM and initial BMI of 41.3 ± 4.8 kg/m2 were studied, 18.7 % undergoing duodenal switch (DS), 34.4 % gastric bypass, and 46.9 % sleeve gastrectomy and followed-up after surgery for 4.6 ± 2.6 years. Changes in BMI, HbA1c, insulin requirements, evolution of comorbidities, and microvascular complications were registered annually after surgery. RESULTS: Percentage of total weight loss (%TWL) 12 months after surgery was 30.4 ± 9.2 % and at 5 years, it decreased to 28.1 ± 11.5 % (p = 0.02). HbA1c was reduced during the first year from 8.5 ± 1.3 to 7.9 ± 1.4 %, p = 0.016. In the long-term, HbA1c returned to baseline values. There was a sustained reduction of 51 % in total daily insulin dose, and the decrease in the number of patients with hypertension, dyslipidemia, and obstructive sleep apnea was 42.8, 25, and 66 %, respectively. Retinopathy remained mainly unaffected, and 25 % of patients with microalbuminuria regressed to normoalbuminuria. CONCLUSIONS: Bariatric surgery in patients with T1DM mainly provides benefits of weight reduction, on insulin requirements, obesity comorbidities, and some benefits in diabetes complications, but might have only minimal effect on the glycemic control in the long term. This trial was registered at www.controlledtrials.com as ISRCTN49980913.
BACKGROUND: This study aims to describe the long-term outcomes of bariatric surgery in a cohort of patients with type 1 diabetes (T1DM). METHODS: Thirty-two patients with T1DM and initial BMI of 41.3 ± 4.8 kg/m2 were studied, 18.7 % undergoing duodenal switch (DS), 34.4 % gastric bypass, and 46.9 % sleeve gastrectomy and followed-up after surgery for 4.6 ± 2.6 years. Changes in BMI, HbA1c, insulin requirements, evolution of comorbidities, and microvascular complications were registered annually after surgery. RESULTS: Percentage of total weight loss (%TWL) 12 months after surgery was 30.4 ± 9.2 % and at 5 years, it decreased to 28.1 ± 11.5 % (p = 0.02). HbA1c was reduced during the first year from 8.5 ± 1.3 to 7.9 ± 1.4 %, p = 0.016. In the long-term, HbA1c returned to baseline values. There was a sustained reduction of 51 % in total daily insulin dose, and the decrease in the number of patients with hypertension, dyslipidemia, and obstructive sleep apnea was 42.8, 25, and 66 %, respectively. Retinopathy remained mainly unaffected, and 25 % of patients with microalbuminuria regressed to normoalbuminuria. CONCLUSIONS: Bariatric surgery in patients with T1DM mainly provides benefits of weight reduction, on insulin requirements, obesity comorbidities, and some benefits in diabetes complications, but might have only minimal effect on the glycemic control in the long term. This trial was registered at www.controlledtrials.com as ISRCTN49980913.
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