Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • Log out
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • Log out
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Online Letters: Observations

Bariatric Surgery Improves the Metabolic Profile of Morbidly Obese Patients With Type 1 Diabetes

  1. Stacy A. Brethauer1,
  2. Ali Aminian1,
  3. Raul J. Rosenthal2,
  4. John P. Kirwan3,
  5. Sangeeta R. Kashyap3 and
  6. Philip R. Schauer1
  1. 1Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH
  2. 2Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
  3. 3Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
  1. Corresponding author: Stacy A. Brethauer, brethas{at}ccf.org.
Diabetes Care 2014 Mar; 37(3): e51-e52. https://doi.org/10.2337/dc13-1736
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • PDF
Loading

A growing body of evidence has demonstrated significant and sustained improvement in glycemic control in type 2 diabetes after bariatric surgery. However, there are limited data on the impact of bariatric surgery in type 1 diabetes (T1D). Only fewer than 10 cases of bariatric surgery in patients with T1D have been reported in the literature, which show a significant weight reduction and improvement in glycemic control (1–3). A recent experimental study in a rat model of spontaneous development of T1D has also shown that a particular type of gastrointestinal bypass (duodenal-jejunal bypass surgery) lowers blood glucose concentration within 2 days after surgery (4). The aim of this study was to assess the metabolic outcomes, including the glycemic status, of patients with T1D after bariatric surgery.

Clinical outcomes and metabolic parameters of 10 morbidly obese patients with poorly controlled T1D who underwent laparoscopic bariatric surgery between 5 January 2005 and 12 December 2012 were retrieved from a database approved by an institutional review board. The diagnosis of T1D was verified for all patients by the presence of pancreatic autoantibodies (islet cell and GAD), absence of C-peptide, and/or documented history of diabetic ketoacidosis. Baseline characteristics, intraoperative data, and postoperative outcomes were assessed, including changes in weight, A1C, daily insulin requirements, lipid panel, and blood pressure. A paired t test was used to analyze changes at the last follow-up point from baseline.

Patients had a male-to-female ratio of 1:9, a mean age of 45.6 ± 10.9 years, a mean baseline BMI of 41.6 ± 3.8 kg/m2, a median duration of T1D of 22 years (range 2–43), and a median of 10 (range 5–13) obesity- or T1D-related comorbidities. One patient had history of coronary bypass and one had history of failed kidney-pancreas transplant. Bariatric procedures included laparoscopic Roux-en-Y gastric bypass (n = 7), adjustable gastric banding (n = 2), and sleeve gastrectomy (n = 1). There were no intraoperative complications and no need for conversion to laparotomy. In total, five postoperative complications occurred, including diabetic ketoacidosis on postoperative day 10, deep vein thrombosis, ulcer at gastrojejunal anastomosis, esophageal dysmotility, and persistent nausea. At a mean follow-up of 36.8 ± 32.3 months, excess weight loss >60% was achieved in all patients except one case of adjustable gastric banding. The mean reduction in BMI of 27.0 ± 9.6% was associated with a significant mean reduction in A1C (10.0 ± 1.6 vs. 8.9 ± 1.1%, P = 0.039) and daily insulin requirement (0.74 ± 0.32 vs. 0.40 ± 0.15 units/kg/day, P = 0.004). There were also favorable changes in LDL (−23.0 ± 19.3 mg/dL, P = 0.02), HDL (10.8 ± 3.4 mg/dL, P = 0.001), and triglyceride (−30.5 ± 17.1 mg/dL, P = 0.007) following surgery (Table 1). Hypertension resolved or improved in 5 of 7 (71%) hypertensive patients. Albuminuria resolved in one of two patients with preoperative microalbuminuria.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 1

Metabolic profile of patients with T1D after bariatric surgery (n = 10)

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 T1D and results in significant improvement in their glycemic status and comorbid conditions, despite having prolonged diabetes and undetectable C-peptide. The favorable metabolic effects of bariatric surgery may facilitate medical management of T1D in the setting of morbid obesity. The true role of bariatric surgery in patients with T1D awaits longer follow-up studies in a larger cohort.

Article Information

Funding. This research was supported in part by National Institutes of Health grant RO1-DK-089547 to P.R.S., J.P.K., and S.R.K.

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Prior Presentation. These data were presented at Obesity Week, a conference of The Obesity Society and the American Society for Metabolic and Bariatric Surgery, Atlanta, GA, 11–16 November 2013.

Author Contributions. S.A.B. and A.A. were responsible for concept development and study design. S.A.B., R.J.R., S.R.K., and P.R.S. were involved in the management of patients. A.A. performed data collection and analysis and drafted the manuscript. S.A.B., A.A., R.J.R., J.P.K., S.R.K., and P.R.S. reviewed the data. S.A.B., R.J.R., J.P.K., S.R.K., and P.R.S. revised and edited the final manuscript. S.A.B. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • © 2014 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

References

  1. ↵
    1. Czupryniak L,
    2. Wiszniewski M,
    3. Szymański D,
    4. Pawłowski M,
    5. Loba J,
    6. Strzelczyk J
    . Long-term results of gastric bypass surgery in morbidly obese type 1 diabetes patients. Obes Surg 2010;20:506–508
    OpenUrlCrossRefPubMed
    1. Mendez CE,
    2. Tanenberg RJ,
    3. Pories W
    . Outcomes of Roux-en-Y gastric bypass surgery for severely obese patients with type 1 diabetes: a case series report. Diabetes Metab Syndr Obes 2010;3:281–283
    OpenUrlPubMed
  2. ↵
    1. Reyes Garcia R,
    2. Romero Muñoz M,
    3. Galbis Verdú H
    . Bariatric surgery in type 1 diabetes. Endocrinol Nutr 2013;60:46–47
    OpenUrlCrossRefPubMed
  3. ↵
    1. Breen DM,
    2. Rasmussen BA,
    3. Kokorovic A,
    4. Wang R,
    5. Cheung GW,
    6. Lam TK
    . Jejunal nutrient sensing is required for duodenal-jejunal bypass surgery to rapidly lower glucose concentrations in uncontrolled diabetes. Nat Med 2012;18:950–955
    OpenUrlCrossRefPubMed
View Abstract
PreviousNext
Back to top
Diabetes Care: 37 (3)

In this Issue

March 2014, 37(3)
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by Author
  • Masthead (PDF)
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Bariatric Surgery Improves the Metabolic Profile of Morbidly Obese Patients With Type 1 Diabetes
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Bariatric Surgery Improves the Metabolic Profile of Morbidly Obese Patients With Type 1 Diabetes
Stacy A. Brethauer, Ali Aminian, Raul J. Rosenthal, John P. Kirwan, Sangeeta R. Kashyap, Philip R. Schauer
Diabetes Care Mar 2014, 37 (3) e51-e52; DOI: 10.2337/dc13-1736

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Bariatric Surgery Improves the Metabolic Profile of Morbidly Obese Patients With Type 1 Diabetes
Stacy A. Brethauer, Ali Aminian, Raul J. Rosenthal, John P. Kirwan, Sangeeta R. Kashyap, Philip R. Schauer
Diabetes Care Mar 2014, 37 (3) e51-e52; DOI: 10.2337/dc13-1736
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Article Information
    • References
  • Figures & Tables
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Tyrosine Kinase Inhibitor Sunitinib Allows Insulin Independence in Long-standing Type 1 Diabetes
  • FGF23 in Type 2 Diabetic Patients: Relationship With Bone Metabolism and Vascular Disease
  • Diabetic Charcot Neuroarthropathy of the Hand: Clinical Course, Diagnosis, and Treatment Options
Show more Online Letters: Observations

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.